Anorectal physiologic testing for bowel dysfunction in patients with spinal cord lesions

PURPOSE: Bowel dysfunction is common in patients with spinal cord lesions. This study aims to determine whether there are any discriminatory findings at anorectal physiologic testing in patients with spinal cord lesions. METH ODS: Twelve consecutive patients (6 females) with significant spinal cord l esions who had mixed symptoms of constipation, fecal impaction, and fecal i ncontinence were evaluated by perfusion manometry and pudendal nerve termin al motor latency. None of the patients had a sphincter defect as evaluated by endoanal ultrasonography. RESULTS: The median age was 54 (range, 40-87) years. Eight (67 percent) of them had had traumatic spinal cord injuries. O ther spinal cord lesions included spina bifida, syringomyelia, arachnoid cy st, and spinal cord ischemia after abdominal aortic aneurysm repair. In pat ients with spinal cord lesions, the mean (range) resting anal canal pressur e and maximum squeeze anal canal pressure a ere 46 (10-100) mmHg and 76 (30 -120) mmHg respectively compared with 62 (50-70) mmHg, and 138 (100-180) mm Hg, respectively, in healthy controls. Eleven (92 percent) patients had pro longed pudendal nerve terminal motor latency (9 bilateral and 2 unilateral) whereas rectoanal inhibitory reflex was abolished in all 9 patients tested . CONCLUSIONS: Spinal patients with severe bowel symptoms tended to have lo wer anal canal pressures than healthy controls. Pudendal neuropathy and imp aired rectoanal inhibitory reflex are common and may be important in the pa thogenesis of bowel dysfunction in patients with spinal cord lesions.