Study of large bowel peristalsis.

Spontaneous colonic peristalsis in man occurs infrequently and, therefore, has proved difficult to investigate; radiological studies have been limited because of the dangers of irradiation, and observations of intraluminal pressure change have been mainly confined to the rectum and lower sigmoid colon (Connell, 1961; Ritchie, Ardran, and Truelove, 1962). Progressive waves of contraction which empty long segments of colon can, however, be stimulated by an enema; such activity is usually called a stripping wave and can be regarded as a form of induced peristalsis1 (Williams, 1967). In the present study, both spontaneous and induced peristalsis of the colon have been studied by balloon kymography and comparisons have been made with rectal activity. (Whenever possible, cineradiology has been used to confirm the findings obtained with balloon kymography.) The study was conducted in two parts. balloons (5 mm x 8 mm), placed 5 cm apart, connected by fine polythene tubing to transducers, and a direct writing recorder, the unit being similar to that described by Atkinson, Edwards, Honour, and Rowlands (1957). The units were introduced into the colon or rectum with a sigmoidoscope with as little distension of the bowel as possible. Access was gained to the transverse and descending colon via well established healthy colostomies, the units being placed as far from the colostomy opening as possible. After introduction of the pressure recording unit, the bowel was left undisturbed for at least 30 minutes before a study was started. The sensitivity of the recorder was adjusted so that a change of pressure of 10 cm of water was represented by a deflection of approximately 1 cm. In certain studies, the pressure changes were also monitored by water-filled open tip tubes (internal diameter 1 mm), in addition to the balloon system. Bisacodyl was used either as suppositories (10 mg) or as a solution in ethylene glycol. Oxyphenisatin was dissolved in water. In seven patients, colonic peristalsis was recorded by simultaneous cineradiology and pressure recording.