Anorectal dysfunction in patients with urologic disturbance due to multiple sclerosis

Area of Science:

• Neuroscience
• Gastroenterology
• Urology

Background:

• Multiple sclerosis (MS) is a demyelinating disease affecting the central nervous system.
• MS can impact various bodily functions, including bladder and bowel control.
• Anorectal dysfunction is a recognized complication in some neurological disorders.

Purpose of the Study:

• To evaluate anorectal function in patients with multiple sclerosis and voiding dysfunction.
• To identify the prevalence and nature of anorectal symptoms in this patient cohort.
• To correlate anal manometry and pudendal nerve function with observed symptoms.

Main Methods:

• Anorectal function assessment in 11 patients with MS and voiding dysfunction.
• Anal manometry to measure anal resting and squeeze pressures.
• Assessment of rectal sensation to distention.
• Pudendal nerve terminal latency measurements.

Main Results:

• Six patients presented with constipation; three had associated obstructed defecation.
• One patient experienced fecal incontinence due to stercoral diarrhea; another had isolated obstructed defecation.
• Anal manometry showed significantly lower anal resting and squeeze pressures in women compared to controls.
• Rectal sensation and pudendal nerve terminal latencies were largely normal, though latency was unmeasurable in some due to poor sphincter contraction.

Conclusions:

• Patients with MS-related voiding dysfunction frequently exhibit anorectal symptoms and motility disorders.
• Reduced anal sphincter function is common, but severe fecal incontinence is not prevalent.
• Constipation may paradoxically protect against fecal incontinence in this population by maintaining anal closure.