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Anorectal physiologic testing for bowel dysfunction in patients with spinal cord lesions.
J J Tjandra1, B S Ooi, W R Han
1Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
Diseases of the Colon and Rectum
|July 26, 2000
Summary
Patients with spinal cord lesions often experience bowel dysfunction. Anorectal testing revealed lower anal pressures and impaired reflexes, suggesting nerve damage contributes to these issues.
Area of Science:
- Neuroscience
- Gastroenterology
- Urology
Background:
- Bowel dysfunction is a frequent complication in individuals with spinal cord lesions.
- Symptoms include constipation, fecal impaction, and fecal incontinence.
- Understanding the underlying anorectal physiology is crucial for effective management.
Purpose of the Study:
- To identify discriminatory findings in anorectal physiologic testing for patients with spinal cord lesions.
- To investigate the role of pudendal nerve function and rectoanal inhibitory reflex in spinal cord injury-related bowel dysfunction.
Main Methods:
- Evaluated 12 patients with spinal cord lesions using perfusion manometry and pudendal nerve terminal motor latency testing.
- Assessed for sphincter defects via endoanal ultrasonography.
- Compared patient results to healthy controls.
Main Results:
- Patients exhibited significantly lower mean resting (46 mmHg) and maximum squeeze (76 mmHg) anal canal pressures compared to controls (62 mmHg and 138 mmHg, respectively).
- 92% of patients demonstrated prolonged pudendal nerve terminal motor latency.
- The rectoanal inhibitory reflex was abolished in all tested patients.
Conclusions:
- Spinal cord lesion patients with severe bowel symptoms show reduced anal canal pressures.
- Pudendal neuropathy and impaired rectoanal inhibitory reflex are common findings.
- These abnormalities are likely significant contributors to the pathogenesis of bowel dysfunction in this population.