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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...

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Autores principales: Marola, Silvia, Ferrarese, Alessia, Gibin, Enrico, Capobianco, Marco, Bertolotto, Antonio, Enrico, Stefano, Solej, Mario, Martino, Valter, Destefano, Ines, Nano, Mario
Formato: Online Artículo Texto
Lenguaje:English
Publicado: De Gruyter Open 2016
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.
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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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