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Effects of psychosensory stimulation on anal pressures: Effects of alfuzosin
Author(s) -
Muthyala Anjani,
Feuerhak Kelly J.,
Harmsen William S.,
Chakraborty Subhankar,
Bailey Kent R.,
Bharucha Adil E.
Publication year - 2019
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13618
Subject(s) - alfuzosin , placebo , stroop effect , internal anal sphincter , psychology , blood pressure , anesthesia , urology , medicine , anal canal , psychiatry , lower urinary tract symptoms , rectum , alternative medicine , cognition , pathology , cancer , prostate
Background Our aim is to explain the lack of clarity in the ways in which anxiety and depression, which are common in defecatory disorders (DD), may contribute to the disorder. In this study, we evaluate the effects of mental stress and relaxation on anal pressures and the mechanisms thereof. Methods In 38 healthy women and 36 DD patients, rectoanal pressures were assessed at rest and during mental stressors (ie, word‐color conflict [Stroop] and mental arithmetic tests) and mental relaxation, before and after randomization to placebo or the adrenergic α 1 ‐antagonist alfuzosin. Key Results During the baseline Stroop test, the anal pressure increased by 6 ± 13 mm Hg (mean ± SD, P = 0.004) in healthy women and 9 ± 10 mm Hg ( P = 0.0001) in constipated women. During mental arithmetic, the anal pressure increased in healthy (4 ± 8 mm Hg, P = 0.002) and constipated women (5 ± 9 mm Hg, P = 0.004). After relaxation, anal pressure declined ( P = 0.0004) by 3 ± 4 mm Hg in DD patients but not in controls. Alfuzosin reduced ( P = 0.0001) anal resting pressure (by 31 ± 19 mm Hg) vs placebo (16 ± 18 mm Hg). However, during the postdrug Stroop test, anal pressure increased ( P = 0.0001) in participants who received alfuzosin but not placebo. Conclusions & Inferences In healthy controls and DD patients, mental stressors likely increased anal pressure by contracting the internal anal sphincter; relaxation reduced anal pressure in DD patients. Alfuzosin reduced anal resting pressure but did not block the Stroop‐mediated contractile response, which suggests that this response is not entirely mediated by adrenergic α 1 receptors.