title: Morphological abnormalities of the recto-anal inhibitory reflex reflects symptom pattern in neurogenic bowel.
abstract: BACKGROUND
  Bowel dysfunction amongst multiple sclerosis (MS) and spinal cord injury (SCI) patients often manifests as fecal incontinence (FI) or constipation, but the pathophysiology is poorly understood. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice.
  
  
  OBJECTIVE
  The purpose of this study was to correlate symptoms of bowel dysfunction in patients with spinal cord disease with findings in anorectal physiology. We hypothesized that specific abnormalities will correlate with symptoms: prolonged recto-anal inhibitory reflex in patients with incontinence and decreased rectal mucosal blood flow in patients with constipation.
  
  
  METHODS
  Forty-nine patients with MS (35 with predominant FI and 14 constipation), 46 supraconal SCI (mixed symptom load), and 21 healthy volunteers matched for age and sex were studied. Subjects completed validated constipation and FI symptom questionnaires. Patients underwent standard anorectal physiology, including assessment of rectal mucosal blood flow and recto-anal inhibitory reflex (RAIR).
  
  
  RESULTS
  Severity of constipation correlates significantly with distension sensitivity (urge volume [r = 0.68, p = 0.002] and maximal volume [r = 0.39, p = 0.03]). Severity of constipation also correlated with diminished rectal mucosal blood flow in both patient groups (r = -0.51, p = 0.006). In both groups, constipation correlated with diminished relaxation of the sphincters in the RAIR whilst fecal incontinence correlated with a prolonged duration of RAIR (r = 0.33, p = 0.009) and recovery phase (r = 0.37, p = 0.05).
  
  
  CONCLUSIONS
  Bowel symptoms in patients with MS and SCI correlate with specific alterations of anorectal physiology. This provides objective assessment of bowel symptoms and may allow tailored treatment to individual patients.
authors.affiliation: Department of Gastroenterology, University College Hospital, London, UK. kum@doctors.net.uk
authors.forename: Kumaran
authors.initials: K
authors.lastname: Thiruppathy
authors.forename: Amanda
authors.initials: A
authors.lastname: Roy
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Preziosi
authors.forename: Jalesh
authors.initials: J
authors.lastname: Pannicker
authors.forename: Anton
authors.initials: A
authors.lastname: Emmanuel
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D016022:Case-Control Studies; D003248:Constipation / Q000503:physiopathology; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D055496:Neurogenic Bowel / Q000209:etiology* / Q000503:physiopathology*; D011446:Prospective Studies; D012007:Rectum / Q000098:blood supply / Q000503:physiopathology*; D012021:Reflex, Abnormal / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D011795:Surveys and Questionnaires