Year 2025 / Volume 117 / Number 9
Original
Rectal sensory-motor alterations — A clinical perspective on anorectal disorders. The correlation between rectal sensation and motility in different anorectal diseases

497-505

DOI: 10.17235/reed.2025.11152/2025

Xinpeng Wang, Yanhui Gao, Li Xiao, Shuang Wang, Bohong Xu, Yu Zhi,

Abstract
Background: Patients with anorectal diseases commonly exhibit abnormalities in rectal sensation Background: patients with anorectal diseases commonly exhibit abnormalities in rectal sensation and/or rectal motility. However, the relationship between rectal sensation and motility in these pathological processes is unclear. This study aimed to explore this association. Methods: a retrospective review was performed of clinical data from 954 patients with anorectal disorders and defecation problems who had undergone anorectal functional testing. The correlation between rectal sensation and motility across various conditions was investigated and the impact of physiological factors assessed. Results: significant rectal sensation differences were seen across constipation, fecal incontinence, rectal cancer, and postoperative patients, with the highest sensitivity in postoperative patients (p < 0.05). Stratified analysis showed constipated patients with rectal hyposensitivity had higher anal resting and maximum squeeze pressures, lower rectoanal gradients, manometric defecation index, and anal relaxation rate (p < 0.05). Further analysis revealed that rectal sensory parameters in constipated patients positively correlated with anal resting and maximum squeeze pressures, and negatively correlated with rectoanal gradients, manometric defecation index, and anal relaxation rate (p < 0.05), with the influence of age and gender being synergistic (p < 0.05). In rectal cancer, the maximum tolerable volume positively correlated with anal resting pressure and negatively with the rectoanal gradient and manometric defecation index (p < 0.05). This negative correlation is also observed in postoperative patients (p < 0.05). Conclusions: in patients with anorectal disorders and defecation problems, there was a significant correlation between rectal sensory abnormalities and dynamic changes induced by varying levels of rectal sensitivity, which were modulated by physiological factors.
Lay Summary
Anorectal disorders are frequently associated with rectal sensory and motor dysfunction, which are key factors leading to severe defecation problems in patients. Throughout the course of the disease and after treatment, alterations in rectal sensation and/or motility may be observed. However, the direct relationship between rectal sensation and motility is not yet understood. This study aimed to investigate this potential association and to refine treatment approaches for enhancing patients’ defecation function. Anorectal manometry was used to assess rectal sensation and motility in patients with various anorectal diseases. The study found significant differences in rectal sensation among patients with constipation, fecal incontinence, rectal cancer, and postoperative patients. Marked differences in rectal motility were reported under varying sensory presentations, particularly in patients with constipation. Additionally, we observed specific correlations between rectal sensation and motility in patients with constipation, rectal cancer, and postoperative patients. Further analysis indicated that in constipated patients, this correlation was influenced by the synergistic interaction of age and gender. In anorectal diseases, changes in rectal sensation may directly lead to alterations in rectal motility, and this sensory-motor correlation may be influenced by physiological factors. Therefore, enhancing rectal sensation and employing personalized treatment strategies to improve rectal motility and alleviate related symptoms may offer a new approach for the treatment of anorectal diseases.
New comment
Comments
No comments for this article
References
1. Patcharatrakul T, Rao SSC. Update on the Pathophysiology and Management of Anorectal Disorders. Gut Liver. 2018;12(4):375-384. Doi: 10.5009/gnl17172
2. Rao SSC, Bharucha AE, Chiarioni G, et al. Anorectal Disorders. Gastroenterology. 2016;150(6):1430-1442.e4. Doi: 10.1053/j.gastro.2016.02.009
3. Corazziari E, Badiali D, Inghilleri M. Neurologic disorders affecting the anorectum. Gastroenterol Clin North Am. 2001;30(1):253-68. Doi: 10.1016/s0889-8553(05)70177-1
4. Camilleri M. Gastrointestinal motility disorders in neurologic disease. J Clin Invest. 2021;131(4)Doi: 10.1172/JCI143771
5. Carrington EV, Scott SM, Bharucha A, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol. 2018;15(5):309-323. Doi: 10.1038/nrgastro.2018.27
6. Scott SM, van den Berg MM, Benninga MA. Rectal sensorimotor dysfunction in constipation. Best Pract Res Clin Gastroenterol. 2011;25(1):103-18. Doi: 10.1016/j.bpg.2011.01.001
7. Mazor Y, Trieu RQ, Prott G, et al. Volumetric Rectal Perception Testing: Is It Clinically Relevant? Results From a Large Patient Cohort. Am J Gastroenterol. 2021;116(12):2419-2429. Doi: 10.14309/ajg.0000000000001526
8. Vollebregt PF, Burgell RE, Hooper RL, et al. Clinical Impact of Rectal Hyposensitivity: A Cross-Sectional Study of 2,876 Patients With Refractory Functional Constipation. Am J Gastroenterol. 2021;116(4):758-768. Doi: 10.14309/ajg.0000000000001039
9. Ratuapli SK, Bharucha AE, Noelting J, et al. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology. 2013;144(2):314-322 e2. Doi: 10.1053/j.gastro.2012.10.049
10. Rhee PL, Choi MS, Kim YH, et al. An increased rectal maximum tolerable volume and long anal canal are associated with poor short-term response to biofeedback therapy for patients with anismus with decreased bowel frequency and normal colonic transit time. Dis Colon Rectum. 2000;43(10):1405-11. Doi: 10.1007/BF02236637
11. Knowles CH, Thin N, Gill K, et al. Prospective randomized double-blind study of temporary sacral nerve stimulation in patients with rectal evacuatory dysfunction and rectal hyposensitivity. Ann Surg. 2012;255(4):643-9. Doi: 10.1097/SLA.0b013e318247d49f
12. Liu K, Chen Y, Lin R, et al. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18. Doi: 10.1016/j.jinf.2020.03.005
13. Seong MK. Assessment of functional defecation disorders using anorectal manometry. Ann Surg Treat Res. 2018;94(6):330-336. Doi: 10.4174/astr.2018.94.6.330
14. Carrington EV, Heinrich H, Knowles CH, et al. The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterol Motil. 2020;32(1):e13679. Doi: 10.1111/nmo.13679
15. Sun X, Wang Z, Xin H, et al. Normative values and its clinical significance of the anorectal manometry in Chinese from multi-center study. Chin J Dig. 2014:597–602. Doi: 10.3760/cma.j.issn.0254-1432.2014.09.005
16. Palit S, Lunniss PJ, Scott SM. The physiology of human defecation. Dig Dis Sci. 2012;57(6):1445-64. Doi: 10.1007/s10620-012-2071-1
17. Thiruppathy K, Mason J, Akbari K, et al. Physiological study of the anorectal reflex in patients with functional anorectal and defecation disorders. J Dig Dis. 2017;18(4):222-228. Doi: 10.1111/1751-2980.12462
18. Ihnat P, Vavra P, Prokop J, et al. Functional outcome of low rectal resection evaluated by anorectal manometry. ANZ J Surg. 2018;88(6):E512-E516. Doi: 10.1111/ans.14207
19. Lu LC, Huang XY, Chen CC. The lived experiences of patients with post-operative rectal cancer who suffer from altered bowel function: A phenomenological study. Eur J Oncol Nurs. 2017;31:69-76. Doi: 10.1016/j.ejon.2017.10.004
20. Ahn JY, Myung SJ, Jung KW, et al. Effect of biofeedback therapy in constipation according to rectal sensation. Gut Liver. 2013;7(2):157-62. Doi: 10.5009/gnl.2013.7.2.157
21. Ozin Y, Ozturk O, Tenlik I, et al. Efficacy of combination of biofeedback therapy and pelvic floor muscle training in dyssynergic defecation. Acta Gastroenterol Belg. 2021;84(4):577-583. Doi: 10.51821/84.4.008
22. Bassotti G, Chistolini F, Sietchiping-Nzepa F, et al. Biofeedback for pelvic floor dysfunction in constipation. BMJ. 2004;328(7436):393-6. Doi: 10.1136/bmj.328.7436.393
23. Neshatian L, Williams MOU, Quigley EM. Rectal Distension Increased the Rectoanal Gradient in Patients with Normal Rectal Sensory Function. Dig Dis Sci. 2021;66(7):2345-2352. Doi: 10.1007/s10620-020-06519-5
24. Jiang Y, Wang Y, Wang M, et al. Clinical significance and related factors of rectal hyposensitivity in patients with functional defecation disorder. Front Med (Lausanne). 2023;10:1119617. Doi: 10.3389/fmed.2023.1119617
25. Abe T, Kunimoto M, Hachiro Y, et al. Effects of Age and Sex on the Anorectal Sensory Threshold to Electrical Stimulation: A Single-center Observational Study. J Anus Rectum Colon. 2023;7(2):74-81. Doi: 10.23922/jarc.2022-063
26. Gundling F, Seidl H, Scalercio N, et al. Influence of gender and age on anorectal function: normal values from anorectal manometry in a large caucasian population. Digestion. 2010;81(4):207-13. Doi: 10.1159/000258662
27. Noelting J, Ratuapli SK, Bharucha AE, et al. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530-6. Doi: 10.1038/ajg.2012.221
28. Knowles CH. Human studies of anorectal sensory function. Ir J Med Sci. 2018;187(4):1143-1147. Doi: 10.1007/s11845-018-1847-5
29. Vasudevan SP, Scott SM, Gladman MA, et al. Rectal hyposensitivity: evaluation of anal sensation in female patients with refractory constipation with and without faecal incontinence. Neurogastroenterol Motil. 2007;19(8):660-7. Doi: 10.1111/j.1365-2982.2007.00922.x
Citation tools
Wang X, Gao Y, Xiao L, Wang S, Xu B, Zhi Y, et all. Rectal sensory-motor alterations — A clinical perspective on anorectal disorders. The correlation between rectal sensation and motility in different anorectal diseases. 11152/2025


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 9 visits.
This article has been downloaded 0 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 12/02/2025

Accepted: 26/04/2025

Online First: 26/05/2025

Published: 15/09/2025

Article revision time: 51 days

Article Online First time: 103 days

Article editing time: 215 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2025 y Creative Commons. The Spanish Journal of Gastroenterology