Background: Visceral pain is a major clinical problem. The aim of the present study was to compare the pain and biomechanical responses to standardized distension of the human colon. Methods: The relation between pain intensity and pressure, cross-sectional area (CSA) and tension-strain relations of the rectum and sigmoid colon were studied in 11 normal subjects following standardized distension using impedance planimetry. The bag was inflated stepwise with pressures up to 6 kPa. The subjects, who were blinded for the distension procedure, rated their pain intensity using an aggregate visual analogue score (VAS) combining the intensity of the feeling of air, urge to defecate and pain. Results: The distensions produced an initial rapid increase in CSA followed by a phase of slow increase until a steady state CSA was reached after 0.5–1 min. Several phasic contractions (observed as short-term decreases in the CSA) were recorded in the rectum from the end of the rapid phase to the end of distension at pressures from 1 to 5 kPa. The CSA in the rectum and sigmoid colon was 3,706 ± 426 mm2 and 2,305 ± 426 mm2 at the maximum bag pressure of 6 kPa (F = 52.4, p < 0.001). The tension-strain relation did not differ between the normal rectum and sigmoid colon. The VAS score for every modality (air, defecation and pain) revealed an increase in intensity as a function of pressure. The VAS score in the rectum and the sigmoid colon as a function of tension and strain did not show any differences. Conclusions: The biomechanical properties in the sigmoid colon and rectum were alike. For a given wall tension and circumferential strain the sensibility seems equal in the rectum and the sigmoid colon. The observed difference in perception between the two segments was related to the greater CSA in the rectum.

Journal Section:
Original Paper: Nerve-Gut Interactions
Keywords:
VAS, Pain, Distensibility, Impedance planimetry, Strain, Tension, Sensibility
1.
Suzuki H, Matsumoto K, Amano S, Fujioka M, Honzumi M: Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 1980;67:655&ndash;657.
[PubMed]
2.
Arhan P, Faverdin C, Persoz B, Devroede G, Dubois F, Dornic C, Pellerin D: Relationship between viscoelastic properties of the rectum and anal pressure in man. J Applied Physiol 1976;41:677&ndash;682.
[PubMed]
3.
Smith AN, Shepherd JJ, Eastwood AA: Pressure changes after balloon distension of the colon wall in diverticular disease. Gut 1981;22:841&ndash;844.
[PubMed]
4.
Rao SSC, Read NW, Davison PA, Bannister JJ, Holdsworth CD: Anorectal sensitivity and responses to rectal distension in patients with ulcerative colitis. Gastroenterology 1987;93:1270&ndash;1275.
[PubMed]
5.
Varma JS, Smith AN, Busuttil A: Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surgery 1985;72:875&ndash;878.
[PubMed]
6.
Wallers DAK, Smith AN, Eastwood MA, Anderson KC, Elton RA, Mugerwa JW: Mechanical properties of the colon: Comparison of the feature of the African and European colon in vitro. Gut 1985;26:384&ndash;392.
[PubMed]
7.
Gregersen H, Kassab GS: Biomechanics of the gastrointestinal tract. Neurogastroenterol Motil 1996;8:277&ndash;297.
[PubMed]
8.
Madoff RD, Orrom WJ, Rothenberger DA, Goldberg SM: Rectal compliance: A critical reappraisal. Int J Colorect Dis 1990;5:37&ndash;40.
[PubMed]
9.
Gregersen H, Andersen AB: Impedance measuring system for quantification of cross-sectional area in the gastrointestinal tract. Med Biol Eng Comput 1986;24:488&ndash;492.
[PubMed]
10.
Gregersen H, Jensen LS, Djurhuus JC: Changes in oesophageal wall biomechanics after portal vein banding and variceal sclerotherapy measured by a new technique. An experimental study in rabbits. Gut 1988;29:1699&ndash;1704.
[PubMed]
11.
Gregersen H, St&oslash;dkilde-J&oslash;rgensen H, Djurhuus JC, Mortensen SD: The four electrode impedance technique: A method for investigation of compliance in luminal organs. Clin Phys Physiol Meas 1988;9(suppl A):61&ndash;64.
12.
Harris JH, Therkelsen EE, Zinner NR: Electrical measurement of ureteral flow; in Boyarsky S, Tanagho EA, Gottschalk CW, Zimskind PD (eds): Urodynamics. London, Academic Press, 1971, pp 465&ndash;472.
13.
Dall FH, J&oslash;rgensen CS, Djurhuus JC, Gregersen H: Biomechanical wall properties of the porcine rectum: A study using impedance planimetry. Dig Dis 1991;9:346&ndash;352.
14.
Dall FH, J&oslash;rgensen CS, Houe D, Gregersen H, Djurhuus JC: Biomechanical wall properties of the human rectum: A study with impedance planimetry. Gut 1993;34:1581&ndash;1586.
[PubMed]
15.
Gregersen H, Orvar K, Christensen J: Biomechanical properties of duodenal wall and duodenal tone during phase I and phase II of the MMC. Am J Physiol 1992;263:G795&ndash;G801.
[PubMed]
16.
Gregersen H, Kraglund K, Djuurhuus JC: Variations in duodenal cross-sectional area during the interdigestive motility complex. Am J Physiol 1990;259:G26&ndash;G31.
[PubMed]
17.
Orvar K, Gregersen H, Christensen J: Biomechanical characteristics of the human oesophagus. Dig Dis Sci 1993;38:197&ndash;205.
[PubMed]
18.
Bell AM, Pemberton JH, Hanson RB, Zinsmeister AR: Variations in muscle tone of the human rectum: Recordings with an electromechanical barostat. Am J Physiol 1991;260:G17&ndash;G25.
[PubMed]
19.
van der Schaar PJ, Lamers CB, Masclee AA: The role of the barostat in human research and clinical practice. Scand J Gastroenterol 1999;230(suppl):52&ndash;63.
20.
Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS: Functional disorders of the anus and rectum. Gut 1999;45(suppl 2):1155&ndash;1159.
21.
Malcolm A, Phillips SF, Camilleri M, Hanson RB: Pharmacological modulation of rectal tone alters perception of distention in humans. Am J Gastroenterol 1997;11:2073&ndash;2079.
22.
Ford MJ, Camilleri M, Zinsmeister AR, Hanson RB: Psychosensory modulation of colonic sensation in the human transverse and sigmoid colon. AGA 1995;0016&ndash;5085.
23.
Dobrin PB: Mechanical properties of arteries. Physiol Rev 1978;58:397&ndash;460.
[PubMed]
24.
Coolsaet B: Bladder compliance and detrusor activity during the collection phase. Neurourol Urodyn 1985;4:263&ndash;273.
25.
Gregersen H: Standardization of barostat procedures. Dig Dis Sci 1998;43:1416&ndash;1418
[PubMed]
26.
Gabella G: Structure of muscle and nerves in the gastrointestinal tract; in Johnson LR, et al (eds): Physiology of the Gastrointestinal Tract, ed 2. New York, Raven Press, 1987, pp 335&ndash;382, vol 1.
27.
Oh ST, Yedidag E, Bielefeldt K: Differential effects of progesterone and its analogues on the contractility of the murine jejunum in vitro. J Surg Res 1998;75:1&ndash;5
[PubMed]
28.
J&auml;nig W, Haupt-Schade P, Kohler W: Afferent Innervation of the Colon: Basic and Clinical Aspects of Chronic Abdominal Pain. Amsterdam, Elsevier, 1993.
29.
Cervero F: Sensory innervation of the viscera: Peripheral basis of visceral pain. Physiol Rev 1994;74:95&ndash;138.
[PubMed]
30.
Maxwell PR: Anorectal sensation and continence. Scand J Gastroenterol 1999;34:113&ndash;116.
[PubMed]
https://doi.org/10.1080/00365529950172934
31.
Brown J, Haines S, Wilding IR: Colonic spread of three rectally administered mesalazine (Pentasa) dosage forms in healthy volunteers as assessed by gamme scintigraphy. Aliment Pharmacol Ther 1997;11:685&ndash;691.
[PubMed]
32.
Distrutti E, Azpiroz F, Soldevilla A, Malagelada JR: Gastric wall tension determines perception of gastric distension. Gastroenterology 1999;116(5):1035&ndash;1042.
© 2001 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2001
You do not currently have access to this content.