Abstract
We studied the anorectal manometric and urodynamic pattern of seven patients who had right andlor left frontal lobe injury to investigate the possibility that the frontal lobe area plays an important role in control of anorectal motility as it does for the urinary bladder. We found that the disturbances of anorectal manometric recordings were similar to those of urodynamic recordings: (1) lack of urinary bladder filling sensation (two cases), increased perception threshold of rectal distension (two cases); (2) uninhibited detrusor contractions during filling (five cases), spontaneous rectal contractions during the resting step (four cases); (3) absence of micturition (one case), absence of rectoanal inhibitory reflex (one case). Furthermore, in all but one patient, we observed a decrease in the amplitude and duration of the voluntary contraction of the anal canal (six cases). However, in two of the seven patients we found hypertonia in the anal canal (upper part: one case, lower part: one case), but never in the urethral canal. Our results suggest that frontal lobe may be involved in the nervous control of anorectal motility as it is for urinary bladder function. However, the lack of correlation between urinary and anorectal anomalies in individual cases suggests that these functions depend on distinct areas of the frontal lobe.
Similar content being viewed by others
References
Andrew J, Nathan PW: Lesions of the anterior frontal lobes and disturbances of micturition and defaecation. Brain 87:233–262, 1964
Khan Z, Hertanu J, Yang WC, Melman A, Leister E: Predictive correlation of urodynamic dysfunction and brain injury after cerebrovascular accident. J Urol 126:86–88, 1981
Tsuchida S, Noto H, Yamaguchi O, Itoh M: Urodynamic studies on hemiplegic patients after cerebrovascular accident. Urology 21:315–318, 1983
Weber J, Denis P, Mihout B, Muller JM, Blanquart F, Galmiche JP, Simon P, Pasquis P: Effect of brain-stem lesion on colonic and anorectal motility. Dig Dis Sci 30:419–425, 1985
First report on the standardization of terminology of lower urinary tract function. Br J Urol 48:39–42, 1976
Blaivas JG, Sinha HP, Zayed AAH, Lakib KB: Detrusor external sphincter dyssynergia: A detailed electromyographic study. J Urol 125:545–548, 1981
Fourth report on the standardisation of terminology of lower urinary tract function. Br J Urol 53:333–335, 1981
Arndorfer RC, Stef JJ, Dodds WJ, Linehan JH, Hogan WJ: Improved infusion system for intraluminal esophageal manometry. Gastroenterology 73:23–27, 1977
Martelli H, Devroede G, Arhan P, Duguay C: Mechanisms of idiopathic constipation: Outlet obstruction. Gastroenterology 75:623–631, 1978
Ducrotté P, Denis P, Galmiche JP, Hellot MF, Desechalliers JP, Colin R, Pasquis P, Hecketsweiler P: Motricité anorectale dans la constipation idiopathique. Etude de 200 patients. Gastroenterol Clin Biol 9:10–15, 1985
Denis P, Colin R, Galmiche JP, Geffroy Y, Hecketsweiler P, Lefrancois R, Pasquis P: Elastic properties of the rectal wall in normal adults and in patients with ulcerative colitis. Gastroenterology 77:45–48, 1979
Abrams P: The urethral pressure profile measurement.In Urodynamics, Principles, Practice and Application. AR Mundy, TP Stephenson, DJ Wein (eds). Edinburgh, Churchill-Livingstone, 1984, pp 127–132
Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, Faverdin C: Some parameters of large bowel motility in normal man. Gastroenterology 75:612–618, 1978
Loening-Baucke V, Anuras S: Anorectal manometry in healthy elderly subjects. J Am Geriatr Soc 32:636–639, 1984
Bannister JJ, Abouzekry L, Read NW: Effect of aging on anorectal function. Gut 28:353–357, 1987
McHugh SM, Diamant NE: Effect of age, gender, and parity on anal canal pressures. Dig Dis Sci 32:726–736, 1987
Bradley WE, Timm GW, Scott FB: Innervation of the detrusor muscle and urethra. Urol North Am 1:3–27, 1974
Tang Pei Chin: Levels of brain stem and diencephalon controlling micturition reflex. J Neurol Physiol 18:583–595, 1955
MacMahon SB, Spillane K: Brain stem influences on the parasympathetic supply to the urinary bladder of the cat. Brain Res 234:237–249, 1982
Denny-Brown D, Robertson G: An investigation of the nervous control of defaecation. Brain 58:256–310, 1935
de Groat WC, Nadelhaft I, Milne RJ, Booth AM, Morgan C, Thor CK: Organization of the sacral parasympathetic reflex pathways to the urinary bladder and large intestine. J Autonom Nerv Syst 3:135–160, 1981
Langworthy OR, Rosenberg J: Control by the central nervous system of rectal smooth muscle. J Neurophysiol 2:356–360, 1939
Fukuda H, Fukai K, Yamane M, Okada H: Pontine reticular unit responses to pelvic nerves and colonic mechanical stimulation in the dog. Brain Res 207:59–71, 1981
Ström G, Uvnas B: Motor responses of gastrointestinal tract and bladder to topical stimulation of the frontal lobe, basal ganglia and hypothalamus in the cat. Acta Physiol Scand 21:90–104, 1950
Moniz E, Lima A: Symptômes du lobe préfrontal. Rev Neur 65:582–595, 1936
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Weber, J., Delangre, T., Hannequin, D. et al. Anorectal manometric anomalies in seven patients with frontal lobe brain damage. Digest Dis Sci 35, 225–230 (1990). https://doi.org/10.1007/BF01536767
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01536767