Journal of Neurology

, Volume 243, Issue 6, pp 445–451 | Cite as

Disturbances of ano-rectal function in multiple sclerosis

  • Annette Mosbæk Nordenbo
  • Jesper Rye Andersen
  • Jens Thorup Andersen
Original Communication

Abstract

Thirty patients with multiple sclerosis (MS) [18 men and 12 women, mean age 40 years (range 22–50), disease duration 12 years (range 0.5–34), Kurtzke's Expanded Disability Status Score 6.0 (range 4.0–7.5)] were interviewed about bowel symptoms and studied using ano-rectal manometry. The results were compared with findings in healthy controls. Twenty-eight had bowel symptoms: 8 constipation, 10 constipation and infrequent faecal urgency, 4 infrequent faecal incontinence and 6 frequent faecal incontinence. Anal sphincter pressure at rest was significantly reduced in MS patients 69 (SD 17) cm H2O, compared with 92 (SD 15) cm H2O in controls, and the external sphincter contraction force was also significantly reduced. Rectal sensation and rectal compliance were reduced and the ano-rectal inhibition reflex (defaecation reflex) required a higher rectal pressure to be elicited in the patients. Upon rectal filling, an early external sphincter excitation was seen. The presence of faecal incontinence correlated strongly with reduced rectal sensation. The findings suggest that faecal incontinence can at least partly be explained by low anal sphincter pressure and poor rectal sensation. The findings of early sphincter excitation and increased threshold of ano-rectal inhibition reflex may be an important pathophysiological factor for constipation in MS patients.

Key words

Autonomic dysfunction Multiple sclerosis Bowel symptoms Anorectal manometry 

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Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Annette Mosbæk Nordenbo
    • 1
    • 2
  • Jesper Rye Andersen
    • 3
  • Jens Thorup Andersen
    • 3
  1. 1.Department of NeurologyHolbaek County HospitalHolbaekDenmark
  2. 2.Department of Neurology, MS Clinic, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Urology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark

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