Periodic rectal motor activity: The intrinsic colonic gatekeeper?

Background: Rectal motor activity is incompletely understood. The aim of this study was to characterize the patterns of rectal motor activity and to examine their diurnal variation and their relationships to proximal colonic activity and to meals. Methods: We performed a 30-h ambulatory motility study by recording pressure activity at multiple sites in the colon in 18 normal subjects. Results: During 288 h of recording, discrete bursts of tonic and phasic activity were seen in the rectum of all subjects at night and during the day lasting ≥3 min, with a predominant frequency of 3 waves/min: periodic rectal motor activity (PRMA). Nocturnally, the number of cycles and the proportion of time occupied by this activity were greater (p < 0.001) and the inter-cycle interval was shorter (p < 0.008) compared with daytime, but the cycle duration was similar. Only 4 versus 5% (nocturnal vs daytime) of cycles propagated aborad, whereas 36 versus 14% (p < 0.01) propagated retrogradely, 16 versus 47% (p < 0.01) occurred simultaneously, and 44 versus 34% were confined to the rectum. There was considerable intra- and intersubject variability. PRMA was not related to meals or to anal motor activity, but 81% of nocturnal and 94% of daytime cycles occurred within 5 min of a motor event in the more proximal colon. Conclusions: PRMA is a characteristic feature of the normal rectum and is more frequent at night. The temporal association with motor events in the proximal colon suggests that PRMA is triggered by the arrival of stool or gas in the rectum. Because most cycles are either segmental or are propagated retrogradely, PRMA may serve as an intrinsic braking mechanism that prevents untimely flow of colonic contents, particularly during sleep.