# RAIR reflex



## 999help (Nov 16, 2012)

Hi, I have this condition

I've researched a lot into muscles / nerves to try to explain odor + rectal inertia. These two symptoms are often ''different sides of the same coin''.

http://books.google.co.uk/books?id=DhQ1A35E8jwC&pg=PA43&lpg=PA43&dq=contraction+in+response+to+anorectal+sampling&source=bl&ots=Ck4nWqqp_-&sig=tFTtQcclQ9V2wbbI9U1vECpwyEY&hl=en&sa=X&ei=iOEsUKLPLO6k0AXLjoHgDA&ved=0CDoQ6AEwATgK#v=onepage&q=contraction%20in%20response%20to%20anorectal%20sampling&f=false

the RAIR reflex is the relaxation of IAS (internal sphincter) to allow contents to come down to be sampled (solid, liquid, gas) by receptors. This happens 7 times per day according to some sources or 7 times per hour according to this source http://lup.lub.lu.se/luur/download?func=downloadFile&recordOId=148995&fileOId=625195

It is accompanied by an automatic contraction of the EAS (external sphincter) http://courses.washington.edu/conj/bess/defecation/defecation.html so that continued contraction would maintain continence or choosing not to contract at appropriate time would allow evacuation of stool/ gas.

+ I forgot to bookmark a source which said ''90% of urge is created by the RAIR anorectal sampling reflex'' - rectal distention itself creates only a slight feeling of pressure.

http://www.ncbi.nlm.nih.gov/pubmed/21188800''Effective evacuation requires a fully functional rectoanal inhibitory reflex (RAIR)-mediated relaxation of the IAS via inhibitory neurotransmission (INT)''

Perhaps the inertia could be explained by an impaired RAIR reflex and the odor caused by the final part playing itself out (breaking the seal) at times other than a movement - ordinary continence / evacuation mechanisms jumbled by the impaired RAIR.

Stool building in the rectum perhaps intitiates the partially-functioning RAIR without any urge, and the IAS / EAS then think that they should be relaxing enough to break the seal ... first + final (missing the middle) parts of the reflex happening in between movements??

When searching on google for evacuation problems: pelvic floor dyssynergia, anismus, paradoxical contractions, non relaxing puborectalis etc etc the comments /discussions from patients almost never mention odor.... It might be possible to trade the odor+evacuation problem for just an evacuation problem with neurotransmitter inhibitors /blockers..or snipping a nerve might not be guaranteed to make things worse.

the chemicals which control IAS are thought to be Nitric oxide, VIP and CO,http://www.ncbi.nlm.nih.gov/pubmed/15836455 (i have extra links about this which I'l find if anyone is interested) they're actions can be blocked by other topical chemicals like L'arganine. if it could be effective for a few hours without altering vital functions elsewhere in the body it might be worth considering - it would be the opposite of nitroglycerine for fissures (fissures need relaxation of IAS)

sufferers of fissures take baths to relieve pain because the warm water relaxes the IAS. For our condition, some have mentioned baths usually have a positive effect for 30-60 mins, maybe the IAS relaxation during a bath re-initiates and does what it should until the next time the RAIR occurs? If that was true, then the same effect could be achieved by inhaling isopropanol butynol etc (poppers) these relax smooth muscles around the body including IAS, although it probably wouldnt be good to be sniffing them all the time....


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## 999help (Nov 16, 2012)

http://www.ncbi.nlm.nih.gov/pubmed/1612356



> ''The NO-synthase inhibitor L-NG-nitro-arginine (L-NNA) caused significant and dose-dependent suppression of the decrease in IASp in response to the reflex mimicked by the rectal balloon distention. NO-synthase inhibitor blocked IAS relaxation in response not only to rectoanal reflex but also to other neural stimuli such as sacral nerve stimulation, local intramural stimulation, and the nicotinic ganglionic stimulant 1,1-dimethyl-4-phenylpiperazinium.''


http://www.ncbi.nlm.nih.gov/pubmed/15836455

It might be relevant if the problem involved reflexes, but probably not a good idea to try it - the tests are based on dissected muscles, the side effects aren't known and could affect other smooth muscles (arterial) - Most tests on the Internal sphincter are to give insight into the functions of other smooth-muscles


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## 999help (Nov 16, 2012)

the L-NG-nitro-arginine (L-NNA) is different to L'arginine, sorry. http://en.wikipedia.org/wiki/Nitroarginine ... http://www.drugs.com/npc/l-arginine.html the body makes nitric oxide out of L'arginine / L-NG-nitro-arginine inhibits the effect of nitric oxide

Injection or absorbed by surface?- the link didn't say, some are topical like glycerin trinitate: http://www.netdoctor.co.uk/digestive-health/medicines/rectogesic.html#ixzz2FZmh5XUc


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## 999help (Nov 16, 2012)

http://europepmc.org/abstract/MED/17542041 L-erythro methoxamine works for 4 hours in humans http://www.ncbi.nlm.nih.gov/pubmed/12854116

Loperamide (over the counter pills) increases pressure/ sphincter tone:

http://www.ncbi.nlm.nih.gov/pubmed/3582899

http://www.ncbi.nlm.nih.gov/pubmed/1294638

http://www.ncbi.nlm.nih.gov/pubmed/7105952



> Loperamide reduces sensitivity of the recto-anal inhibitory reflex and increases internal anal sphincter tone





> a rise in the tone of the sphincter and the inhibition of its relaxation in response to rectal distention





> This action was associated with an increase in the maximum basal sphincter pressure, an increase in the rectal volume required to abolish recovery of the rectoanal inhibitory reflex, and a reduction in rectal compliance


Also: http://ajpgi.physiology.org/content/294/4/G1084.full / https://www.jstage.jst.go.jp/article/jsmr/45/1/45_1_1/_pdf talks about restoring ordinary function by ''Using the plasticity of enteric nervous pathways''


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