|dc.contributor.author||Burgell, Rebecca Elizabeth||
|dc.identifier.citation||Burgell, R.E. 2014.||en_US
|dc.description||The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the author||en_US
Rectal hyposensitivity (RH) is associated with functional hindgut disorders.
It is hypothesized to involve afferent pathway dysfunction. However, little
is known regarding its clinical impact.
To assess whether RH is:
• clinically important and associated with specific symptoms;
• secondary to afferent neuronal dysfunction; and
• primarily a pelvic abnormality.
Epidemiological studies were conducted: (1) a case-controlled study
stratified by sensory status, assessing symptoms of constipation and
incontinence, health status and quality of life; (2) an observational study
exploring RH in faecal incontinence in men; (3) an observational study
examining the impact of RH on defaecatory urge.
Pathophysiological studies were also conducted: (1) transmission of
visceral sensory information was evaluated using rectal evoked potentials;(2) somatic sensory function and visceral efferent function were examined
in patients with and without RH.
RH is associated with constipation. Patients with RH have more severe
symptoms and worse health status and quality of life. Constipated patients
report altered defaecatory urge compared to controls, most notably in
those with RH.
RH is associated with concurrent constipation and evacuatory dysfunction
in males with incontinence.
Patients with RH have delayed evoked potential latencies, without
alteration of cortical activation. A proportion have elevated somatic
sensory thresholds although efferent function is similar between groups.
1. In patients with constipation, those with RH have a worse clinical
phenotype, with poorer health status and quality of life. Patients
with constipation, (particularly those with RH), have alteration of
2. RH and constipation may contribute to incontinence in males where
sphincter dysfunction is less important. 3. RH is associated with delayed afferent transmission indicating
primary afferent pathway dysfunction. In a proportion, reflecting a
possible generalised sensory neuropathy.
These studies confirm that intact rectal sensation is fundamental to normal
hindgut function. Impaired visceral sensation is thus an important
|dc.publisher||Queen Mary University of London||en_US
|dc.subject||functional hindgut disorders||en_US
|dc.subject||constipation and evacuatory dysfunction||en_US
|dc.title||The role of rectal hyposensitivity in the development of functional hindgut disorders: clinical significance and pathophysiology||en_US