Skip to main content

Advertisement

SpringerLink
Log in

The Sphincter of O’Beirne – Part 1: Study of 18 Normal Subjects

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Gastroenterologists have ignored or emphasized the importance of the rectosigmoid junction in continence or constipation on and off for 200 years. Here, we revisit its significance using high-resolution colonic manometry.

Methods

Manometry, using an 84-channel water-perfused catheter, was performed in 18 healthy volunteers.

Results

The rectosigmoid junction registers as an intermittent pressure band of 26.2 ± 7.2 mmHg, or intermittent phasic transient pressure increases at a dominant frequency of 3 cpm and an amplitude of 28.6 ± 8.6 mmHg; or a combination of tone and transient pressures, at a single sensor, 10–17 cm above the anal verge. Features are its relaxation or contraction in concert with relaxation or contraction of the anal sphincters when a motor pattern such as a high-amplitude propagating pressure wave or a simultaneous pressure wave comes down, indicating that such pressure increases or decreases at the rectosigmoid junction are part of neurally driven programs. We show that the junction is a site where motor patterns end, or where they start; e.g. retrogradely propagating cyclic motor patterns emerge from the junction.

Conclusions

The rectosigmoid junction is a functional sphincter that should be referred to as the sphincter of O’Beirne; it is part of the “braking mechanism,” contributing to continence by keeping content away from the rectum. In an accompanying case report, we show that its excessive presence in a patient with severe constipation can be a primary pathophysiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

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

References

  1. O’Beirne J. New Views of the Process of Defecation, and Their Application to the Pathology and Treatment of Diseases of the Stomach, Bowels, and Other Organs. Dublin: Hodges and Smith; 1833.

    Google Scholar 

  2. O’Beirne J. Organic structure of the rectum. Lancet. 1834;21:712–719.

    Article  Google Scholar 

  3. Ballantyne GH. Rectosigmoid sphincter of O’Beirne. Dis Colon Rectum. 1986;29:525–531.

    Article  CAS  Google Scholar 

  4. Balli R. Le rontgendiagnostic surtout au point de vue des organes de l’abdomen. Acta Radiol. 1928;89–106.

  5. Balli R. The sphincters of the colon. Radiology. 1939;33:372–376.

    Article  Google Scholar 

  6. Baker WNW, Mann CV. The rectosigmoid junction zone, another sphincter? In: Thomas PA, Mann CV, eds. Alimentary Sphincter and Their Disorders. London: Palgrave Macmillan; 1981:201–211.

    Chapter  Google Scholar 

  7. Buntzen S, Nordgren S, Hultén L, Delbro D. The role of nitric oxide in the acetylcholine-induced relaxation of the feline internal anal sphincter, in vitro. Scand J Gastroenterol. 1996;31:1189–1194.

    Article  CAS  Google Scholar 

  8. Cook TA, Brading AF, Mortensen NJ. The pharmacology of the internal anal sphincter and new treatments of ano-rectal disorders. Aliment Pharmacol Ther. 2001;15:887–898.

    Article  CAS  Google Scholar 

  9. Hill JR, Kelley ML, Schlegel JF, Code CF. Pressure profile of the rectum and anus of healthy persons. Dis Colon Rectum. 1960;3:203–209.

    Article  CAS  Google Scholar 

  10. Chen J-H, Collins SM, Milkova N, Pervez M, Nirmalathasan S, Wei T, Hanman A, Huizinga JD. The sphincter of O’Beirne – Part 2: report of a case of chronic constipation with autonomous dyssynergia. Dig Dis Sci. (Epub ahead of print). https://doi.org/10.1007/s10620-020-06723-3.

  11. Chen J-H, Parsons SP, Shokrollahi M, et al. Characterization of simultaneous pressure waves as biomarkers for colonic motility assessed by high-resolution colonic manometry. Front Physiol Gastrointest Sci. 2018;9:1248. https://doi.org/10.3389/fphys.2018.01248.

    Article  Google Scholar 

  12. Milkova N, Parsons SP, Ratcliffe E, Huizinga JD, Chen JH. On the nature of high-amplitude propagating pressure waves in the human colon. Am J Physiol Gastrointest Liver Physiol. 2020;318:G646–G660.

    Article  CAS  Google Scholar 

  13. Wadhwa RP, Mistry FP, Bhatia SJ, Abraham P. Existence of a high pressure zone at the rectosigmoid junction in normal Indian men. Dis Colon Rectum. 1996;39:1122–1125.

    Article  CAS  Google Scholar 

  14. Ritchie JA, Tuckey MS. Intraluminal pressure studies at different distances from the anus in normal subjects and in patients with the irritable colon syndrome. Am J Dig Dis. 1969;14:96–106.

    Article  CAS  Google Scholar 

  15. Chowdhury AR, Dinoso VP, Lorber SH. Characterization of a hyperactive segment at the rectosigmoid junction. Gastroenterology. 1976;71:584–588.

    Article  CAS  Google Scholar 

  16. Shafik A, Mostafa RM, Shafik AA. Electrophysiological study of the rectosigmoid canal: evidence of a rectosigmoid sphincter. J Anat. 2002;200:517–521.

    Article  Google Scholar 

  17. Fisher R, Cohen S. Physiological characteristics of the human pyloric sphincter. Gastroenterology. 1973;64:67–75.

    Article  CAS  Google Scholar 

  18. Code CF, Fyke FE, Schlegel JF. The gastroesophageal sphincter in healthy human beings. Gastroenterologia. 1956;86:135–150.

    Article  CAS  Google Scholar 

  19. Shafik A. The hypertonic rectosigmoid junction: description of a new clinicopathologic entity causing constipation. Surg Laparosc Endosc. 1997;7:116–120.

    Article  CAS  Google Scholar 

  20. Culligan K, Coffey JC, Kiran RP, Kalady M, Lavery IC, Remzi FH. The mesocolon: a prospective observational study. Colorectal Dis. 2012;14:421–428. (discussion 428).

    Article  CAS  Google Scholar 

  21. Irving MH, Catchpole B. ABC of colorectal diseases. Anatomy and physiology of the colon, rectum, and anus. BMJ. 1992;304:1106–1108.

    Article  CAS  Google Scholar 

  22. McNeil NI, Rampton DS. Is the rectum usually empty?—A quantitative study in subjects with and without diarrhea. Dis Colon Rectum. 1981;24:596–599.

    Article  CAS  Google Scholar 

  23. Shafik A, Ali YA, Afifi R. Is the rectum a conduit or storage organ. Int Surg. 1997;82:194–197.

    CAS  PubMed  Google Scholar 

  24. Malcolm A, Camilleri M. Coloanal motor coordination in association with high-amplitude colonic contractions after pharmacological stimulation. Am J Gastroenterol. 2000;95:715–719.

    Article  CAS  Google Scholar 

  25. Lin AY, Dinning PG, Milne T, Bissett IP, O’Grady G. The “rectosigmoid brake”: review of an emerging neuromodulation target for colorectal functional disorders. Clin Exp Pharmacol Physiol. 2017;44:719–728.

    Article  CAS  Google Scholar 

  26. Shafik A. Sigmoido-rectal junction reflex: role in the defecation mechanism. Clin Anat. 1996;9:391–394.

    Article  CAS  Google Scholar 

  27. Lierse W, Frohmuller H, Stelzner F, Stegner H-E. In: Lang J, Wachsmuth W, eds. Applied Anatomy of the Pelvis. Berlin: Springer; 1984.

    Google Scholar 

  28. Moszkowicz D, Peschaud F, Bessede T, Benoit G, Alsaid B. Internal anal sphincter parasympathetic-nitrergic and sympathetic-adrenergic innervation: a 3-dimensional morphological and functional analysis. Dis Colon Rectum. 2012;55:473–481.

    Article  Google Scholar 

  29. Mills K, Hausman N, Chess-Williams R. Characterization of the alpha1-adrenoceptor subtype mediating contractions of the pig internal anal sphincter. Br J Pharmacol. 2008;155:110–117.

    Article  CAS  Google Scholar 

  30. Mills K, Chess-Williams R. Pharmacology of the internal anal sphincter and its relevance to faecal incontinence. Auton Autacoid Pharmacol. 2009;29:85–95.

    Article  CAS  Google Scholar 

  31. Shafik A. Recto-colic reflex: role in the defecation mechanism. Int Surg. 1996;81:292–294.

    CAS  PubMed  Google Scholar 

  32. Rao SS, Welcher K. Periodic rectal motor activity: the intrinsic colonic gatekeeper. Am J Gastroenterol. 1996;91:890–897.

    CAS  PubMed  Google Scholar 

  33. Lin AY, Du P, Dinning PG, et al. High-resolution anatomic correlation of cyclic motor patterns in the human colon: evidence of a rectosigmoid brake. Am J Physiol Gastrointest Liver Physiol. 2017;312:G508–G515.

    Article  Google Scholar 

  34. Pervez M, Ratcliffe E, Parsons SP, Chen J-H, Huizinga JD. The cyclic motor patterns in the human colon. Neurogastroenterol Motil. 2020;e13807:1–17. https://doi.org/10.1111/nmo.13807.

    Article  Google Scholar 

  35. Chen J-H, Yang Z, Yu Y, Huizinga JD. Haustral boundary contractions in the proximal 3-taeniated colon of the rabbit. Am J Physiol. 2016;310:G181–G192.

    Article  Google Scholar 

  36. Yoneda S, Fukui H, Takaki M. Pacemaker activity from submucosal interstitial cells of Cajal drives high-frequency and low-amplitude circular muscle contractions in the mouse proximal colon. Neurogastroenterol Motil. 2004;16:621–627.

    Article  CAS  Google Scholar 

  37. Chen J-H, Yu Y, Yang Z, et al. Intraluminal pressure patterns in the human colon assessed by high-resolution manometry. Sci Rep. 2017;7:41436. https://doi.org/10.1038/srep41436.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Broens PM, Penninckx FM, Ochoa JB. Fecal continence revisited: the anal external sphincter continence reflex. Dis Colon Rectum. 2013;56:1273–1281.

    Article  Google Scholar 

  39. Broens PMA, Jonker JE, Trzpis M. The puborectal continence reflex: a new regulatory mechanism controlling fecal continence. Int J Colorectal Dis. 2018;33:627–633.

    Article  Google Scholar 

Download references

Acknowledgments

JDH received a Canadian Foundation for Innovation John Evans Leadership Grant for the equipment used in this study. The hardware was designed in collaboration with Medical Measurement Systems. The catheters were designed in collaboration with Howard Mui and staff at Mui Scientific. Sharjana Nirmalathasan was supported in part by a scholarship from NSERC. This study was supported by an operating grant to JDH from the Canadian Institutes of Health Research PJT-152942. The authors acknowledge the continuing support from Elyanne Ratcliffe, David Armstrong, Stephen M. Collins, and staff at the Endoscopy Unit.

Author information

Authors and Affiliations

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

    Ji-Hong Chen, Sharjana Nirmalathasan, Maham Pervez, Natalija Milkova & Jan D. Huizinga

Authors
  1. Ji-Hong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sharjana Nirmalathasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maham Pervez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natalija Milkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan D. Huizinga
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All HRCM studies were carried out by JHC. Analysis was carried out by SN, MP and NM and the interpretation of data was done by JHC, SN, NM, MP and JDH. All authors contributed to manuscript writing and all approved the final version.

Corresponding author

Correspondence to Ji-Hong Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, JH., Nirmalathasan, S., Pervez, M. et al. The Sphincter of O’Beirne – Part 1: Study of 18 Normal Subjects. Dig Dis Sci 66, 3516–3528 (2021). https://doi.org/10.1007/s10620-020-06657-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06657-w

Keywords

Search

Navigation