title: Impairment of anorectal function in diabetes mellitus parallels duration of disease.
abstract: OBJECTIVE
  The aim of this study was to investigate any possible relation between the severity of anorectal dysfunction in diabetes mellitus and duration of disease and presence of microangiopathy or neuropathy or both.
  
  
  METHODS
  Standard multiport anorectal manometry was performed in 25 healthy control subjects (10 males; age (mean +/- 1 standard deviation), 62 +/- 14 years) and 38 patients with diabetes mellitus. Patients were divided into two groups according to the duration of the disease: Group A (19 patients) with a duration less than 10 years (7.2 +/- 2.5; 8 males; age, 57 +/- 18) and Group B (19 patients) with a duration longer than 10 years (19.8 +/- 5.6; 6 males; age, 62 +/- 15).
  
  
  RESULTS
  Results are reported as mean +/- one standard deviation. Patients showed lower resting and squeeze anal pressures (P < 0.01), impaired rectoanal inhibitory and anocutaneous reflexes, and reduced sensitivity in rectal distention (P = 0.004) as compared with controls. In addition, Group B showed a significantly increased incidence of microangiopathy (P = 0.04) and autonomic and peripheral neuropathy (P = 0.002), significantly reduced basal and squeeze anal pressures (52 +/- 16 vs. 64 +/- 24 mmHg; P = 0.03 and 98 +/- 39 vs. 124 +/- 54 mmHg; P = 0.04, respectively), reduced amplitude of slow waves (7.3 +/- 3 ts. 9.5 +/- 3.7 mmHg; P = 0.03), anal leak in smaller rectal volumes (P = 0.003), and reduced response of the anal sphincter at the anocutaneous reflexes (29 +/- 14 vs. 39 +/- 14 mmHg; P = 0.05) compared with Group A. The former group of patients exhibited a significantly higher incidence of fecal incontinence (P = 0.008).
  
  
  CONCLUSIONS
  Patients with long-standing diabetes mellitus have increased incidence of fecal incontinence and severely impaired function of both the anal sphincters and the rectum. These findings could be attributed to the increased incidence of microangiopathy and autonomic and peripheral neuropathy observed in this subset of diabetic patients.
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Medical School of Crete, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Epanomeritakis
authors.forename: P
authors.initials: P
authors.lastname: Koutsoumbi
authors.forename: I
authors.initials: I
authors.lastname: Tsiaoussis
authors.forename: E
authors.initials: E
authors.lastname: Ganotakis
authors.forename: M
authors.initials: M
authors.lastname: Vlata
authors.forename: J S
authors.initials: JS
authors.lastname: Vassilakis
authors.forename: E
authors.initials: E
authors.lastname: Xynos
mesh_terms: D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology*; D001341:Autonomic Nervous System / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000150:complications / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011312:Pressure; D012007:Rectum / Q000294:innervation / Q000503:physiopathology; D012018:Reflex; D012720:Severity of Illness Index; D013997:Time Factors