Anorectal function in patients with complete supraconal spinal cord lesions.

MacDonagh, Riodrach; Sun, Wei; Thomas, D. G.; Smallwood, R. H.; Read, N W

doi:10.1136/gut.33.11.1532

Cited by 86 publications

(58 citation statements)

References 16 publications

(9 reference statements)

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“…[9][10][11][12][13] SCI patients lose a variable proportion of their extrinsic autonomic innervation to their gut, depending on the level of injury, whereas the intrinsic enteric nervous system remains intact. 3 The gut intrinsic nervous system may lose integrity with time because of the loss of extrinsic supply.…”

Section: Introductionmentioning

confidence: 99%

Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients

et al. 2009

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Study design: Investigation of bowel function in 55 patients and 26 healthy volunteers using radiological, anorectal physiological and laser Doppler blood flow monitoring. Objectives: Bowel dysfunction is common after spinal cord injury (SCI). We aimed to determine whether hindgut testing of autonomic innervation provides insight into presence of symptoms, altered motor function (transit) and level of injury. Setting: St Mark's Hospital, UK and The Spinal Injuries Unit, Royal National Orthopaedic Hospital, UK. Methods: A total of 55 patients with chronic complete SCI and 26 healthy volunteers were studied. Twenty-four patients had lesions above T5 and 31 had lesions below T5. Thirty-five patients complained of constipation: 75% (18/24) of patients with lesions above T5 and 55% (17/31) of those with lesions below T5. Gut transit, rectal electrosensitivity and rectal blood flow were measured. Results: Slow gut transit occurred in 65% of patients and in all the 35 patients complaining of constipation. Delay was pancolonic. All patients had an elevated sensory threshold. The threshold was significantly higher in those with subjective constipation (Po0.01), slow transit (Po0.04) and high SCI (P ¼ 0.046). Mucosal blood flow was lower in SCI patients with constipation (Po0.04) and slow transit (Po0.03). It was higher than normal in high-SCI volunteers (P ¼ 0.056), reflecting loss of sympathetic inhibition. Conclusions: In SCI, subjective constipation correlates closely with slow gut transit. Delay is pancolonic, regardless of the site of lesion. Sensory testing provides evidence for completeness of lesion, offering further evidence for pain transmission through sympathetic pathways. Studies in SCI patients provide further evidence of mucosal blood flow as a marker of altered autonomic innervation.

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Section: Introductionmentioning

confidence: 99%

Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients

et al. 2009

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“…[1][2][3][4] Colonic transit times are often prolonged, [5][6][7][8] and anorectal sensibility and voluntary control of the external anal sphincter is reduced or lost. 5,9,10 The severity of colorectal and anal sphincter dysfunction depends on the completeness of SCI 3 and constipation-related symptoms become significantly more severe with time since injury. 1,11 To facilitate a comparison of symptoms, treatment modalities, and outcomes between patients, various centers and countries it would be advantageous to collect data on bowel symptoms after SCI in the form of common international data sets.…”

Section: Introductionmentioning

confidence: 99%

International bowel function basic spinal cord injury data set

et al. 2008

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Study design: International expert working group. Objective: To develop an International Bowel Function Basic Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on bowel function in daily practice or in research. Setting: Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). Methods: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCoS Scientific Committee and the ASIA Board. Relevant and interested scientific and professional (international) organizations and societies (approximately 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, Council and ASIA Board received the data set for final review and approval. Results: The International Bowel Function Basic SCI Data Set includes the following 12 items: date of data collection, gastrointestinal or anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, awareness of the need to defecate, defecation method and bowel care procedures, average time required for defecation, frequency of defecation, frequency of fecal incontinence, need to wear pad or plug, medication affecting bowel function/constipating agents, oral laxatives and perianal problems. Conclusion: An International Bowel Function Basic SCI Data Set has been developed.

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“…The transmission of noxious sensation is through the lumbar (sympathetic) nerves [15,16]. Sacral afferent (parasympathetic) fibres are thought to be primarily responsible for the conduction of visceral non-noxious sensation from the anorectum [16][17][18][19].…”

Section: Physiology Of the Anorectummentioning

confidence: 99%

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

Thiruppathy¹,

Preziosi²

2014

J Neurol Neurophysiol

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Bowel dysfunction amongst multiple sclerosis (MS) patients often manifests as faecal incontinence (FI), constipation, or a combination of the two. Its pathophysiology is poorly understood and can be multifactorial. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice. Due to the varied and fluctuant nature of the symptoms, these patients can be a management challenge. This review aims to give an overview of the pathophysiology, clinical manifestations and the principles of management of multiple sclerosis patients with bowel dysfunction.

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Anorectal function in patients with complete supraconal spinal cord lesions.

Cited by 86 publications

References 16 publications

Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients

Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients

International bowel function basic spinal cord injury data set

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

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