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Anal sphincter dysfunction in multiple sclerosis: an observation manometric study
Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple scle...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
De Gruyter Open
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329875/ https://www.ncbi.nlm.nih.gov/pubmed/28352843 http://dx.doi.org/10.1515/med-2016-0088 |
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author | Marola, Silvia Ferrarese, Alessia Gibin, Enrico Capobianco, Marco Bertolotto, Antonio Enrico, Stefano Solej, Mario Martino, Valter Destefano, Ines Nano, Mario |
author_facet | Marola, Silvia Ferrarese, Alessia Gibin, Enrico Capobianco, Marco Bertolotto, Antonio Enrico, Stefano Solej, Mario Martino, Valter Destefano, Ines Nano, Mario |
author_sort | Marola, Silvia |
collection | PubMed |
description | Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis. 136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient. RESULTS: Group A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively). CONCLUSIONS: The decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy. |
format | Online Article Text |
id | pubmed-5329875 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | De Gruyter Open |
record_format | MEDLINE/PubMed |
spelling | pubmed-53298752017-03-28 Anal sphincter dysfunction in multiple sclerosis: an observation manometric study Marola, Silvia Ferrarese, Alessia Gibin, Enrico Capobianco, Marco Bertolotto, Antonio Enrico, Stefano Solej, Mario Martino, Valter Destefano, Ines Nano, Mario Open Med (Wars) Research Article Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis. 136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient. RESULTS: Group A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively). CONCLUSIONS: The decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy. De Gruyter Open 2016-11-25 /pmc/articles/PMC5329875/ /pubmed/28352843 http://dx.doi.org/10.1515/med-2016-0088 Text en © 2016 S. Marola et al. http://creativecommons.org/licenses/by-nc-nd/3.0 This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. |
spellingShingle | Research Article Marola, Silvia Ferrarese, Alessia Gibin, Enrico Capobianco, Marco Bertolotto, Antonio Enrico, Stefano Solej, Mario Martino, Valter Destefano, Ines Nano, Mario Anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
title | Anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
title_full | Anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
title_fullStr | Anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
title_full_unstemmed | Anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
title_short | Anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
title_sort | anal sphincter dysfunction in multiple sclerosis: an observation manometric study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329875/ https://www.ncbi.nlm.nih.gov/pubmed/28352843 http://dx.doi.org/10.1515/med-2016-0088 |
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