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The Sphincter of O’Beirne—Part 2: Report of a Case of Chronic Constipation with Autonomous Dyssynergia

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Abstract

Background

Chronic constipation can have one or more of many etiologies, and a diagnosis based on symptoms is not sufficient as a basis for treatment, in particular surgery.

Aim

To investigate the cause of chronic constipation in a patient with complete absence of spontaneous bowel movements.

Methods

High-resolution colonic manometry was performed to assess motor functions of the colon, rectum, the sphincter of O’Beirne and the anal sphincters.

Results

Normal colonic motor patterns were observed, even at baseline, but a prominent high-pressure zone at the rectosigmoid junction, the sphincter of O’Beirne, was consistently present. In response to high-amplitude propagating pressure waves (HAPWs) that were not consciously perceived, the sphincter and the anal sphincters would not relax and paradoxically contract, identified as autonomous dyssynergia. Rectal bisacodyl evoked marked HAPW activity with complete relaxation of the sphincter of O’Beirne and the anal sphincters, indicating that all neural pathways to generate the coloanal reflex were intact but had low sensitivity to physiological stimuli. A retrograde propagating cyclic motor pattern initiated at the sphincter of O’Beirne, likely contributing to failure of content to move into the rectum.

Conclusions

Chronic constipation without the presence of spontaneous bowel movements can be associated with normal colonic motor patterns but a highly exaggerated pressure at the rectosigmoid junction: the sphincter of O’Beirne, and failure of this sphincter and the anal sphincters to relax associated with propulsive motor patterns. The sphincter of O’Beirne can be an important part of the pathophysiology of chronic constipation.

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Abbreviations

HRCM:

High-resolution colonic manometry

HAPW:

High-amplitude propagating pressure wave

HAPW-SPW:

High-amplitude propagating pressure wave followed by a simultaneous pressure wave

SPW:

Simultaneous pressure wave

RAIR:

Recto-anal inhibitory reflex

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Acknowledgments

JDH received a Canadian Foundation for Innovation John Evans Leadership Grant for the equipment used in this study. Operating funds were obtained from the Canadian Institutes of Health Research (CIHR, 152942) to JDH. The Farncombe Family Digestive Health Research Institute provided partial salary support for J-HC. The hardware was designed in collaboration with Medical Measurement Systems. The catheters were designed in collaboration with Howard Mui and staff at Mui Scientific. Parts of this research were presented at the Canadian Digestive Diseases Week of 2018 [56] and the Federation of Neurogastroenterology and Motility, 2018 [57].

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Authors and Affiliations

  1. Department of Medicine-Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, HSC-3H1F, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada

    Ji-Hong Chen, Stephen M. Collins, Natalija Milkova, Maham Pervez, Sharjana Nirmalathasan, Wei Tan, Alicia Hanman & Jan D. Huizinga

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  1. Ji-Hong Chen
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  2. Stephen M. Collins
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  3. Natalija Milkova
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  4. Maham Pervez
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  5. Sharjana Nirmalathasan
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  6. Wei Tan
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  7. Alicia Hanman
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  8. Jan D. Huizinga
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Contributions

Study design, data interpretation and writing of manuscript, J-HC and JDH. Execution of HRCM and clinical care, J-HC. Clinical care, data interpretation, critical revision of the manuscript, SMC. Data analysis, data interpretation and manuscript writing NM, MP, SN, WT, AH. All authors approved the final version of the manuscript.

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Correspondence to Ji-Hong Chen.

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The authors declare that there was no conflict of interest of any kind.

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All procedures were approved by the Hamilton Integrated Research Ethics Board (HiREB); the patient gave written informed consent.

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Chen, JH., Collins, S.M., Milkova, N. et al. The Sphincter of O’Beirne—Part 2: Report of a Case of Chronic Constipation with Autonomous Dyssynergia. Dig Dis Sci 66, 3529–3541 (2021). https://doi.org/10.1007/s10620-020-06723-3

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