Anorectal physiology following spinal cord injury

Purpose: Spinal cord injured (SCI) patients have delayed colonic motility a nd anorectal dysfunction resulting in functional obstruction and constipati on. This may be caused by changes in descending modulation from the central or sympathetic nervous systems. Anorectal dyssynergy may demonstrate simil arities to that seen in the bladder following SCI. Methodology: Anorectal manometry was performed on 37 SCI volunteers. Patter ns of rectal and sphincter function were identified. These patterns were th en compared with questionnaire answers on bowel function and cystometrogram s to identify a relationship between detrusor dyssynergy and anal sphincter tone. Results: Rectal compliance and basal resting sphincter pressures were lower than normal values. Ramp rectal inflation demonstrated patterns of sphinct er activity similar to that recorded in the patients' cystometrograms. Ther e is no definite relationship of bowel function to the findings on manometr y in SCI patients. Conclusions: SCI patients have abnormal anorectal function. Anorectal manom etry results were able to be classified into four patterns on the basis of rectal pressure and sphincter tone in response to rectal distention. The pa tterns of anorectal manometry seen were similar to those in cystometrograms , however there is no definite relationship to bowel dysfunction.