title: Autonomic rectal dysfunction in patients with multiple sclerosis and bowel symptoms is secondary to spinal cord disease.
abstract: BACKGROUND
  Most patients with multiple sclerosis report bowel symptoms, but the underlying pathophysiology is unclear.
  
  
  OBJECTIVE
  We hypothesize that rectal dysfunction in multiple sclerosis is secondary to involvement of the spinal cord by the disease and that this can be measured by assessing rectal compliance.
  
  
  METHODS
  This was a case-control study.
  
  
  METHODS
  The study took place in a neurogastroenterology clinic and tertiary referral center.
  
  
  METHODS
  Forty-five patients with multiple sclerosis, 19 with a spinal cord injury above T5, and 25 normal control subjects were included in this study. Patients with multiple sclerosis were subdivided into 2 groups according to the Expanded Disability Status Scale, below 5 (multiple sclerosis minor disability, n = 25) or above 5 (multiple sclerosis major disability, n = 20), as a reflection of spinal cord involvement.
  
  
  METHODS
  Rectal compliance, Wexner constipation, and Wexner incontinence scores were measured.
  
  
  RESULTS
  Data are presented as mean and SD. Expanded Disability Status Scale correlated with rectal compliance but not with Wexner constipation or Wexner incontinence scores. Post hoc analysis showed no significant difference in Wexner constipation and Wexner incontinence between the 2 multiple sclerosis groups.
  
  
  CONCLUSIONS
  Limitations to this study include the lack of an asymptomatic group with multiple sclerosis and the small sample size to evaluate bowel symptoms.
  
  
  CONCLUSIONS
  Rectal compliance correlates with disability, and observed alterations in the rectal properties are secondary to spinal cord involvement. Our findings suggest that, in patients with neurologic impairment, rectal compliance is a surrogate of reflex activity of the spinal cord regulating rectal function and both a potential predictor of outcome and target for treatment. Multiple sclerosis patient subgroups had similar symptom burden, arguing that bowel dysfunction is multifactorial.
authors.affiliation: 1Gastrointestinal Physiology Unit, University College London Hospitals, London, United Kingdom 2Division of Surgery and Interventional Science, University College London, London, United Kingdom 3Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom 4Division of General Surgery, University College London, London, United Kingdom 5University College London Institute of Neurology, London, United Kingdom.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Preziosi
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Raptis
authors.forename: Amanda
authors.initials: A
authors.lastname: Raeburn
authors.forename: Jalesh
authors.initials: J
authors.lastname: Panicker
authors.forename: Anton
authors.initials: A
authors.lastname: Emmanuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology*; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology* / Q000503:physiopathology; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D012007:Rectum / Q000503:physiopathology*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D055815:Young Adult