Fecal continence and the puborectal continence reflex.

Jonker, J. (Jara) (2015) Fecal continence and the puborectal continence reflex. thesis, Medicine.

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Abstract

Introduction It has been recently described that the conscious and unconscious contraction of the puborectal muscle is required for fecal continence. The conscious contraction is regulated with involvement of the brain and the unconscious contraction is regulated by the puborectal continence reflex. In this study we investigated whether the puborectal continence reflex is regulated by the same nerve pathway as the conscious contraction of puborectal muscle. Further we aimed to find whether the unconscious and conscious contractions are influenced by each other, age and gender. Methods We included all the 283 patients who underwent anorectal function tests between 2010 and 2014 at the UMCG. In total 189 patients were excluded because of possible generalized innervations damage or operations in the pelvic region after which 94 patients remained. The patients underwent three anorectal function test. First, to investigate sensory condition of the pudendal nerve, they underwent the anal electrosensitivity test. Second, to measure the conscious contraction, they underwent the anorectal pressure test. Finally, to measure the unconscious contraction, they underwent the balloon retention test. Results We found no correlation between the unconscious contraction and the anal electrosensitivity (P: 0.811). In contrast, we found a correlation between the conscious contraction and the anal electrosensitivity (P: 0.012). There was no correlation between the conscious and unconscious contraction (P: 0.634). Age had no influence on the unconscious, neither on the conscious contraction (P: 0.080 and P: 0.344, respectively). Gender had no influence on the unconscious contraction (P: 0.673). However, gender did have a significantly influence the conscious contraction (P<0.001), since men had a significant stronger conscious contractions. Conclusion We conclude that the nerve pathway responsible for the puborectal continence reflex is different than that one responsible for the conscious contraction of the puborectal muscle. Further, the conscious and unconscious contraction work independently from each other. In addition, age and gender have no influence on the unconscious contraction. Further clinical studies are necessary to evaluate the exact nerve pathway responsible for the puborectal continence reflex.

Item Type:	Thesis (Thesis)
Supervisor name:	Broens, Dr. P.M.A.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:01
Last Modified:	25 Jun 2020 11:01
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2099

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