Original Article

International Journal of Colorectal Disease

, Volume 26, Issue 4, pp 507-513

First online:

Modulation of the rectoanal inhibitory reflex (RAIR): qualitative and quantitative evaluation in multiple sclerosis

  • Amandine GuinetAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP Email author 
  • , Marylène JousseAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP
  • , Mireille DamphousseAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP
  • , Kathelyne HubeauxAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP
  • , Frédérique Le BretonAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP
  • , Samer Sheikh IsmaelAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP
  • , Gérard AmarencoAffiliated withService de Neuro-Urologie et Explorations Périnéales, Unité de Recherche Er6 UPMC, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, APHP

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Abstract

Background

Rectoanal inhibitory reflex (RAIR) is a physiological modulated reflex involved in anorectal continence and defined by a relaxation of internal anal sphincter following rectal distension. Its existence depends on intramural autonomic ganglions and its modulation on the integrity of the autonomic nervous system (ANS).

Aims

The aim of this study was to analyse RAIR modulation in terms of amplitude and duration in multiple sclerosis (MS) patients.

Methods

Twenty-one patients with MS and 40 control patients had anorectal manometry. Qualitative assessment (presence or absence) of RAIR was evaluated together with its modulation in amplitude and in duration.

Results

All patients had present RAIR for each volume of rectal distension (10–50 ml). Seven patients (33.3%) in the MS group had abnormal RAIR modulation in amplitude (odds ratio (OR) = 2.78, compared to control group, p = 0.11). Nine patients (42.9%) in the MS group had abnormal RAIR modulation in duration (p = 0.14, OR = 2.54, compared to control group). Alteration of RAIR modulation was not correlated with Expanded Disability Status Scale, faecal incontinence and constipation (p > 0.05). Course of MS (relapsing–remitting MS or secondary progressive form) seems to be correlated to alteration of modulation in amplitude and in duration (OR = 1.31 and 1.07).

Conclusion

Even if our results do not have the required statistical significance (p > 0.05), they are interesting. If RAIR is always present in MS, its modulation seems to be altered. A hypothesis for this lack of RAIR modulation could be the alteration of ANS, often involved in MS besides somatic nervous system lesions.

Keywords

Multiple sclerosis Recto anal inhibitory reflex (RAIR) Modulation Anorectal manometry Bowel symptoms