Intra-anal application of l-erythro methoxamine gel increases anal resting pressure in patients with incontinence

Abstract

Abstract Background This study examined the effects of a single dose of intra-anal l-erythro methoxamine on mean anal resting pressure (MARP) and cardiovascular variables in patients with faecal incontinence. Methods Patients had anorectal physiology tests and ultrasonography before participating. Six patients received 0·3 and 1 per cent gels on separate days, two patients received 0·3 per cent gel, and two patients received 1 per cent gel. MARP, blood pressure, pulse rate and plasma drug concentrations were measured for 6 h after application. Results Intra-anal 0·3 per cent gel caused a rapid, significant rise in MARP lasting 2 h (P = 0·036). In four of these patients, the response was sufficient to increase MARP to within the normal range at 2 h. Application of 1 per cent gel caused a significant rise in MARP for 4 h after application (P = 0·028). There was a significant decrease in pulse at 2 and 1 h respectively after application of 0·3 and 1 per cent gels. Conclusion Intra-anal application of l-erythro methoxamine can be used to increase MARP in patients with faecal incontinence. Application of 1 per cent l-erythro methoxamine gel produced a rapid, sustained rise in MARP, which raises the possibility of therapeutic application.