Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy

Sun, Weiming; MacDonagh, Riodrach; Förster, David; Thomas, D. G.; Smallwood, R. H.; Read, N W

doi:10.1016/0016-5085(95)90194-9

Cited by 77 publications

(47 citation statements)

References 17 publications

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“…11 ± 13 These are the most important mechanisms for continence in man. 13 Three patients who had continuous faecal incontinence, were constipated. In these patients (C4, T5 and T6) we can suspect a mechanism of over¯ow incontinence due to faecal stasis in the colon.…”

Section: Discussionmentioning

confidence: 99%

Constipation and other chronic gastrointestinal problems in spinal cord injury patients

et al. 1998

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From a questionnaire sent to 90 spinal cord injury (SCI) patients it is concluded that 58% of patients with a complete SCI above L2 suer from constipation, de®ned as two or fewer bowel movements per week, or the use of aids such as laxatives, manual evacuation or enemas. Tetraplegic patients had the highest prevalence of constipation, while patients with low paraplegia were less prone to constipation. The use of anticholinergic drugs was found to predispose to constipation. Preserved rectal sensation did not in¯uence the presence of constipation. Faecal incontinence was rare. Regular abdominal pain was present in one third of SCI patients and might be caused by an irritable bowel syndrome in 62% of these.

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Section: Discussionmentioning

confidence: 99%

Constipation and other chronic gastrointestinal problems in spinal cord injury patients

et al. 1998

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“…The effect of rhizotomy and the response to feeding have been investigated in SCI patients. 5,17 There are, however, some methodological problems with these techniques. 12 Impedance planimetry determines rectal CSA, thereby avoiding some of the inherent sources of error with pressure-volume measurements.…”

Section: Electrical Stimulation Of the Dgn Vs Spinal Cord Injury J Womentioning

confidence: 99%

“…2,3 Most authors have found that rectal compliance is reduced in patients with supraconal SCI and data suggest that it is increased in those with conal or cauda equina lesions. 4,5 One group has found increased rectal compliance in patients with conal or cauda equina lesions. 6 Neurogenic bowel dysfunction is usually treated conservatively with oral laxatives, suppositories and digital anorectal stimulation.…”

Section: Introductionmentioning

confidence: 99%

Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury

et al. 2012

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Background: Constipation and fecal incontinence are considerable problems for most individuals with spinal cord injury (SCI). Neurogenic bowel symptoms are caused by several factors including abnormal rectal wall properties. Stimulation of the dorsal genital nerve (DGN) can inhibit bladder contractions and because of common innervation inhibitory effects are anticipated in the rectum too. Therefore, DNG could have a future role in the treatment of neurogenic fecal incontinence. Aim: To study the effect of acute DGN stimulation on the rectal cross sectional area (CSA) in SCI patients. Methods: Seven patients with complete supraconal SCI (median age 50 years) were included. Stimulation was applied via plasterelectrodes using an amplitude of twice the genito-anal reflex threshold (pulse width: 200 ms; pulse rate: 20 Hz). A pressure controlled phasic (10, 20 and 30 cmH 2 O) rectal distension protocol was repeated four times with subjects randomized to stimulation during 1st and 3rd distension series or 2nd and 4th distension series. The rectal CSA and pressure were measured using impedance planimetry and manometry. Results: All patients completed the investigation. Median stimulation amplitude was 51 mA (range 30-64). CSA was smaller during stimulation and differences reached statistical significance at distension pressures of 20 cmH 2 O (average decrease 9%; P¼0.02) and 30 cmH 2 O (average decrease 4%; P¼0.03) above resting rectal pressure. Accordingly, rectal pressure-CSA relation was significantly reduced during stimulation at 20 (P¼0.03) and 30 cmH 2 O distension (P¼0.02). Conclusion: DGN Stimulation in patients with supraconal SCI results in an acute decrease of rectal CSA and the rectal pressure-CSA relation.

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“…Spinal cord injuries (SCI) affect colorectal motility, [1][2][3] transit times [4][5][6][7] and emptying at defecation. 8 Accordingly, most SCI patients suffer from constipation and faecal incontinence, [9][10][11][12][13][14] often resulting in restricted social activities and impaired quality of life (QOL).…”

Section: Introductionmentioning

confidence: 99%

Neurogenic bowel dysfunction score

et al. 2005

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Study design: Cross-sectional questionnaire study. Objectives: To develop and validate a symptom-based score for neurogenic bowel dysfunction (NBD): NBD score. Setting: University Hospital of Aarhus, Denmark. Methods: A questionnaire including questions about background parameters (n ¼ 8), faecal incontinence (n ¼ 10), constipation (n ¼ 10), obstructed defecation (n ¼ 8), and impact on quality of life (QOL) (n ¼ 3) was sent to 589 Danish spinal cord injured (SCI) patients. The reproducibility and validity of each item was tested in 20 and 18 patients, respectively. Associations between items and impact on QOL were determined by logistic regression analysis. The NBD score was constructed from items with acceptable reproducibility and validity that were significantly associated with impact on QOL. Based on odds ratios for associations between items and impact on QOL, each item was given a corresponding number of points in the NBD score. Results: A total of 424 SCI patients responded. The following 10 items met the criteria above: frequency of bowel movements (0-6 points), headache, perspiration or discomfort before or during defecation (0-2 points), tablets and drops against constipation (0-2 points each), time used for each defecation (0-7 points), frequency of digital stimulation or evacuation (0-6 points), frequency of faecal incontinence (0-13 points), medication against faecal incontinence (0-4 points), flatus incontinence (0-2 points) and perianal skin problems (0-3 points). Differences in NBD score among patients reporting no, little, some or major impact on QOL were statistically significant (all Po0.001). Conclusion: Based on valid and reproducible questions, we have constructed a score for NBD that is correlated to impact on QOL.

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Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy

Cited by 77 publications

References 17 publications

Constipation and other chronic gastrointestinal problems in spinal cord injury patients

Constipation and other chronic gastrointestinal problems in spinal cord injury patients

Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury

Neurogenic bowel dysfunction score

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