The symptoms of distal ulcerative colitis have been related to changes in rectal sensitivity and capacity due to inflammation, altered gastrointestinal motility, and sensory perception. With the use of anorectal manometry, the function was measured in seven patients with active distal proctitis during local treatment with ropivacaine. Seven healthy subjects were studied in the same way for comparison with normal conditions. The anal resting pressure and squeezing pressure were similar in all groups. Significantly lower rectal distention volumes were required for rectal sensation, critical volume, and to induce rectal contractility in patients with active disease compared to controls. Rectal compliance was significantly reduced in patients with active and quiescent disease. The increased rectal sensitivity and contractility in patients with active colitis appear to be related to active mucosal inflammation and ulceration. The frequency and urgency of defecation and the fecal incontinence may be due to a hypersensitive, hyperactive, and poorly compliant rectum. The findings in our study indicate that the inflammatory damage to the rectal wall with poor compliance is unaffected by local anaesthetics such as ropivacaine. The symptomatic relief and reduction in clinical symptoms following treatment are not reflected in the anorectal manometric findings. 1. Introduction Ulcerative colitis (UC) is characterised by intermittent flares of active disease with bowel symptoms. These symptoms include an increased frequency of bowel movements, urgency, sensation of incomplete evacuation, and tenesmi [1]. Alterations in colonic motility may contribute to the increased urgency and frequency of defecation [2, 3], and an increased rectal sensitivity and reactivity is associated with active inflammation [4–7]. Clinical symptoms in active UC are considered to be secondary to the inflammatory process reflecting alterations in the function of smooth muscle, enteric neurotransmission, or afferent sensory input from the bowel wall [8–11]. A long-acting local anaesthetic, ropivacaine, has been explored as a potential therapy for UC [12]. An open clinical study of patients with active distal CU treated with 200？mg rectal ropivacaine gel twice daily indicated a prompt symptomatic relief including a decrease in the number of stools and tenesmi [13]. In addition to reversible block of nerve pulse propagation, ropivacaine affects a variety of cell functions in the inflammatory response [14–18]. Thus the reduction of clinical symptoms can be related to an attenuation of the
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