title: Altered Colorectal Compliance and Anorectal Physiology in Upper and Lower Motor Neurone Spinal Injury May Explain Bowel Symptom Pattern.
abstract: Supraconal spinal cord injury (SCI) and lower motor neurone spinal cord injury (LMN-SCI) cause bowel dysfunction; colorectal compliance may further define its pathophysiology. The aim of this study was to investigate rectal (RC) and sigmoid (SC) compliance and anorectal physiology parameters, in these subjects.
  
  
  
  Twenty-four SCI subjects with gut symptoms (14 RC, 10 SC) and 13 LMN-SCI subjects (9 RC, 4 SC) were compared with 20 spinal intact controls (10 RC, 10 SC). Staircase distensions were performed using a barostat. Anorectal manometry, including rectoanal inhibitory reflex (RAIR) measurement, was performed in all. Data presented as mean±standard error (SCI/LMN-SCI vs. controls).
  
  
  
  SCI subjects had a higher RC (17.0±1.9 vs. 10.7±0.5 ml/mm Hg, P<0.05) and SC (8.5±0.6 vs. 5.2±0.5 ml/mm Hg, P=0.002). LMN-SCI subjects had a lower RC (7.3±0.7 ml/mm Hg, P=0.0021) while SC was unchanged (8.3±2.2 ml/mm Hg, P>0.05). Anal resting pressure was decreased in SCI (55±5 vs. 79±7 cmH2O, P=0.0102). Anal squeeze pressure was decreased in LMN-SCI (76±13 vs. 154±21 cmH2O, P=0.0158). In SCI and LMN-SCI, the amplitude reduction of the RAIR was greater (62±4% and 70±6% vs. 44±3%, P=0.0007).
  
  
  
  Colorectal compliance abnormalities may explain gut symptoms: increased RC and SC contributing to constipation in SCI, reduced rectal compliance contributing to fecal incontinence (FI) in LMN-SCI. Reduced resting anal pressure in SCI and reduced anal squeeze pressure in LMN-SCI along with a greater RAIR amplitude reduction may be factors in FI. These co-existing abnormalities may explain symptom overlap, and represent future therapeutic targets to ameliorate neurogenic bowel dysfunction.
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.|Department of Surgery, St Peter's Hospital, Surrey, UK.
authors.forename: Prateesh M
authors.initials: PM
authors.lastname: Trivedi
authors.affiliation: GI Physiology Unit, University College Hospital, London, UK.
authors.forename: Lalit
authors.initials: L
authors.lastname: Kumar
authors.affiliation: GI Physiology Unit, University College Hospital, London, UK.|Spinal Cord Injuries Centre, Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: Anton V
authors.initials: AV
authors.lastname: Emmanuel
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D003248:Constipation / Q000209:etiology / Q000503:physiopathology; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000209:etiology* / Q000503:physiopathology*; D012021:Reflex, Abnormal / Q000502:physiology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology*; D011795:Surveys and Questionnaires