Pain intensity and biomechanical responses during ramp-controlled distension of the human rectum

The current study aimed to refine the conventional distension model in the human rectum by measuring the cross-sectional area with a ramp-controlled impedance planimetric system. After preconditioning, the rectum in seven volunteers was distended 56 times with infusion rates of 50, 100 and 200 ml/min and at 100 ml/min during relaxation of the smooth muscle with glucagon. The pump was reversed at maximal tolerated pain. The subjects tolerated a higher volume and pressure with a more reliable sensory rating after preconditioning of the tissue. The three distension rates resulted in different pressure and tension at the maximal pain intensity ( P < 0.02 and P < 0.05) with a decrease after relaxation of the smooth muscle with glucagon ( P < 0.05). On the other hand, the cross-sectional area and volume were robust, did not show strain-rate dependency, and were not affected by muscle relaxation. Since the cross-sectional area is directly related to the deformation of the gut wall and hence to the strain, the study supports the idea that, independent of the muscular function, the mechano sensitive nociceptors in the human rectum depend directly on circumferential wall strain rather than on pressure and tension.