Anorectal function of children with neurological problems. II: cerebral palsy

In response to the frequent complaint of difficulties with defecation experienced by children with cerebral palsy, 34 children (13 girls and 21 boys, mean age 10 years) with cerebral palsy were investigated by questionnaire and anorectal manometry. 24 enuretic children served as controls for the anorectal manometry. Constipation affected 26 of 29, defecation distress eight and faecal incontinence 16 of the index children, but incontinence was mild in most cases. Index children had a low resting pressure in the first centimetre of the anal canal, slow anal rhythmical activity and a pressure increase in the first centimetre during maximum rectal distension. These findings suggest anal sphincter and/or pelvic floor muscle incoordination, but no evidence of abnormal rectal function. The authors conclude that surgical intervention was not indicated for the index children, but that medical treatment could be improved.