International Journal of Colorectal Disease

, Volume 8, Issue 4, pp 220–224 | Cite as

Multiple sclerosis: Assessment of colonic and anorectal function in the presence of faecal incontinence

  • D. J. Waldron
  • P. G. Horgan
  • F. R. Patel
  • R. Maguire
  • H. E. Given
Original Articles

Abstract

Six females suffering from Multiple Sclerosis (MS) with symptoms of constipation and faecal incontinence were investigated using anal manometry, proctometrogram, proctography and large bowel transit time estimates (using inert markers). Results were compared to a control group (4 females, 2 males). Resting anal sphincter pressure (internal sphincter function) was reduced, but not significantly so, compared with controls (46±12.6 vs. 68±8.2 mm Hg: P>0.1). Maximum squeeze increment pressure (external sphincter function) was significantly diminished in the patient group (13.5±4.5 vs. 82.5±12.3 mm Hg: P>0.0001). Radiological imaging of the anorectum demonstrated an abnormal position of the pelvic floor at rest, with moderate descent in most cases during straining. Measurement of anorectal angles (puborectalis muscle function) indicated a normal angle at rest (76±10.4 degrees), but with little change on maximum contraction (74±3.5 degrees) and on straining (79±4.6 degrees). Rectal sensory parameters did not differ from controls either for minimum sensation, 44.5±5.2 vs. 30±5.8 ml (P>0.1), or at maximum tolerable volume, 163±34.5 vs. 148±22 ml (P>0.2). Four of six patients failed to empty 100% of simulated stool at proctography, at which the only anatomical defect was the presence of a rectocele in two patients. Large bowel transit studies revealed abnormally slow transit in 82% of patients, all of whom had delay in the distal colon. These physiological studies demonstrate that in patients with MS who had anorectal dysfunction, there is a marked impairment of external anal sphincter function with moderate changes in pelvic floor musculature. Delayed distal colonic transit may be associated with inability to completely evacuate the rectum.

Résumé

Six femmes souffrant de scléroses en plaques avec des symptômes de constipation, et d'incontinence fécale ont été étudiées par manométrie anale, proctométrogramme, défécographie et temps de transit intestinal (utilisant des marqueurs inertes). Les résultats ont été comparés à un groupe contrôle (4 femmes et 2 hommes). La pression anale de repos (fonction sphinctérienne interne) était réduite mais de façon non significative comparée au contrôle (46±12.6 vs. 68±8.2 mm Hg: P>0.1). La pression maximale de rétention (fonction sphinctérienne externe) etait significativement diminuée dans le groupe de malades (13.5±4.5 vs. 82.5±12.3 mm Hg: P>0.0001). Les images radiologiques montraient une position anormale du plancher pelvien au repos avec une descente modérée dans la plupart des cas au cours de l'effort. La mesure de l'angle anorectal (fonction du muscle puborectal) indiquait un angle normal au repos (76±10.4 degré) mais avec peu de changement lors de la contraction maximum (74±3.5 degré) ou de l'effort d'évacuation (79±4.6 degré). Les paramétres sensitifs rectaux ne différaient pas des contrôles soit pour la sensation minimale (44.5±5.2 vs. 30±5.8 ml, P>0.1) ou le volume maximum tolérable (163±34.5 vs. 148±22 ml, P>0.2). 4 des 6 patients ne pouvaient évacuer 100% de la selle factice à la défécographie, au cours de laquelle le seul défaut anatomique était la presence d'une rectocèle chez 2 patients. Le temps de transit colique révélait un transit anormalement lent chez 82% des patients, tous ayant un retard dans le colon distal. Ces études physiologiques montrent que chez les patients avec sclérose en plaque et mauvais fonctionnement anorectal, il y a une altération marquée de la fonction sphinctérienne externe avec des modifications modérées de la musculature du plancher pelvien. Le retard au temps de transit colique peut être associé avec l'impossibilité d'évacuer complètement le rectum.

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References

  1. 1.
    Antel JP, Aranson BJW (1987) Demyelinating Diseases. In: Braunwald E, Isselbacher KJ, Petersdorf RG, Wilson JD, Martin JB, Fauci AS. Harrison's Principles of Internal Medicine. 11th ed McGraw-Hill New York pp 1995–1999Google Scholar
  2. 2.
    Sullivan SN, Ebers GC (1983) Gastrointestinal dysfunction in Multiple Sclerosis. Gastroenterology 84:1640Google Scholar
  3. 3.
    Glick ME, Meshkinpour H, Haldeman S, Bhatia NN, Bradley WE (1982) Colonic dysfunction in Multiple Sclerosis. Gastroenterology 83:1002–1007Google Scholar
  4. 4.
    Weber J, Grise P, Roquebert M, Hellot MF, Mihout B, Samson M, Beuret-Blanquart F, Pasquis P, Denis P (1987) Radiopaque marker transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction. Dis Colon Rectum 30:95–100Google Scholar
  5. 5.
    Hinds JP, Eidelman BH, Wald A (1990) Prevalence of bowel dysfunction in Multiple Sclerosis. A population survey. Gastroenterology 98:1538–1542Google Scholar
  6. 6.
    Duthie HL, Bennett RC (1963) The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal incontinence. Gut 4:179–182Google Scholar
  7. 7.
    Hinton JM, Lennard-Jones J, Young AC (1969) A new method for studying gut transit times using radiopaque markers. Gut 10:842–847Google Scholar
  8. 8.
    Editorial (1982) The bladder in Multiple Sclerosis. J Roy Soc Med 75: 75–76Google Scholar
  9. 9.
    Schoenberg HW, Gutrich J, Banno J (1979) Urodynamic patterns in Multiple Sclerosis. J Urol 122:648–650Google Scholar
  10. 10.
    Beersiek F, Parks AG, Swash M (1979) Pathogenesis of anorectal incontinence: a histometrick study of the anal sphincter musculature. J Neurol Sci 42:111–127Google Scholar
  11. 11.
    Womack NR, Morrison JFB, Williams NS (1988) Prospective study of the effects of postanal repair in neurogenic faecal incontinence. Br J Surg 75:48–52Google Scholar
  12. 12.
    Miller R, Bartolo DCC, Locke-Edmunds JC, Mortensen NJMcC (1988) Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 75:101–105Google Scholar
  13. 13.
    Henry MM, Parks AG, Swash M (1982) The pelvic floor musculature in the descending perineum syndrome. Br J Surg 69:470–472Google Scholar
  14. 14.
    Bartolo DCC, Roe AM, Virjee J, Mortensen NJMcC (1985) Evacuation proctography in obstructed defaecation and rectal intussusception. Br J Surg 72 (Suppl):S111–116Google Scholar
  15. 15.
    Hallan RIH, Williams NS, Waldron DJ, Womack NR, Morrison JFB (1988) Role of rectal intussusception in the development of anal incontinence. Br J Surg 75:1269Google Scholar
  16. 16.
    Lane RHS, Parks AG (1977) Function of the anal sphincters following coloanal anastomosis. Br J Surg 64:596–599Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • D. J. Waldron
    • 1
    • 2
  • P. G. Horgan
    • 1
  • F. R. Patel
    • 1
  • R. Maguire
    • 1
  • H. E. Given
    • 1
  1. 1.Department of Surgery and RadiologyUniversity College HospitalGalwayIreland
  2. 2.Department of SurgeryRegional HospitalWiltonIreland

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