Analysis of rhythmic rectal contractions during filling cystometry in women

ABSTRACT

Purpose: Rhythmic or random rectal contractions independent of bladder activity are frequently observed during cystometry and usually attributed either to a neurological disease, or to ageing. The aim of our study was to search for an association of rhythmic rectal contractions (RRCs) with a specific lower urinary tract symptom or/and an urodynamic diagnosis. Materials and Methods: The population consisted of 534 consecutive women with lower urinary tract symptoms and without specific gastro-intestinal disease referred for urodynamics; 382 (non-ND) had no history of neurological disease and 152 (ND) a history of neurological disease. Cystometries were performed according to ICS recommendations. Rectal pressure was measured using a punctured balloon filled with 2 mL of saline. RRCs were defined as rhythmic changes in the rectal pressure of at least 3 cm H2O independent of the total vesical pressure. Results: RRCs were observed in 69 patients, with no difference in neurological status or age (non-ND 12.3 percent and 65.5y; ND 14.5 percent and 62.7y). Patients with RRCs were significantly older than the negative population (p = 0.0002). RRCs had a low frequency 1 - 4/min; their amplitude was ¡Ü 15 cm H2O in 67 patients. RRCs were associated with urgency (35 patients) whatever the neurological status and with detrusor overactivity only in the neurological patients. Conclusions: RRCs cannot be considered as artefactual events during cystometry in women, occur in the older population, are frequently associated with urgency but not with detrusor overactivity or neurological disease. Occurrence of RRCs should prompt the physician to look at the possible causes of urgency (colonic or bladder).