S1826 Translumbar and Transsacral Magnetic Stimulation–a Novel Test of Assessing Anorectal Neuropathy in Fecal Incontinence

Rao, Satish S.; Tantiphlachiva, Kasaya; Attaluri, Ashok; Paulson, Jessica; Remes-Troche, José María; Yamada, Thoru

doi:10.1016/s0016-5085(08)61293-7

Cited by 4 publications

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“…Depending on the site of stimulation and recording, afferent and efferent pathways can be evaluated 59, 60 . Confirming proof of concept, motor evoked potentials after anal and rectal stimulation were prolonged in patients with spinal cord injury and bowel dysfunction 61 and also in FI 62 . These techniques may enhance our understanding of anorectal dysfunctions, in particular the mechanisms of impaired voluntary relaxation in DD or unexplained anal weakness in FI.…”

Section: Fecal Incontinencesupporting

confidence: 52%

An Update on Anorectal Disorders for Gastroenterologists

2014

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Gastroenterologists frequently encounter pelvic floor disorders, which affect 10–15% of the population. The anorectum is a complex organ that collaborates with the pelvic floor muscles to preserve fecal continence and enable defecation. A careful clinical assessment is critical for the diagnosis and management of defecatory disorders and fecal incontinence. Newer diagnostic tools (e.g., high resolution manometry and magnetic resonance defecography) provide a refined understanding of anorectal dysfunctions and identify phenotypes in defecatory disorders and fecal incontinence. Conservative approaches including biofeedback therapy are the mainstay for managing these disorders; new minimally-invasive approaches may benefit a subset of patients with fecal incontinence but more controlled studies are needed. This mini-review highlights these advances, current concepts and controversies in the area.

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Section: Fecal Incontinencesupporting

confidence: 52%

An Update on Anorectal Disorders for Gastroenterologists

2014

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“…The technique is simple, objective, and painless 21 . It may also be useful for the evaluation of subjects with other disorders of pelvic floor, such as fecal incontinence 33 . Given the complex innervation of the rectum and the anal canal and the patchy nature of neurological injury, we believe that it is prudent to evaluate MEP at all 8 sites in order to obtain optimal information.…”

Section: Discussionmentioning

confidence: 99%

Translumbar and Transsacral Motor-Evoked Potentials: A Novel Test for Spino-Anorectal Neuropathy in Spinal Cord Injury

Tantiphlachiva

Attaluri

Valestin

et al. 2011

American Journal of Gastroenterology

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Introduction Spinal cord injury (SCI) causes anorectal problems, whose pathophysiology remains poorly characterized. A comprehensive method of evaluating spino-anorectal function is lacking. Aim To investigate the neuropathophysiology of bowel dysfunction in SCI by evaluating motor evoked potentials (MEP) of anus and rectum following trans-spinal magnetic stimulation and anorectal physiology. Methods Translumbar and transsacral magnetic stimulations, anorectal manometry and pudendal nerve latency (PNTML) were performed in 39 subjects with SCI and anorectal problems and 14 healthy controls and data were compared. MEPs were recorded with an anorectal probe containing bipolar ring electrodes. Results The MEPs were significantly prolonged (p<0.05) bilaterally, and at lumbar and sacral levels, and at rectal and anal sites in SCI subjects compared to controls. 95% of SCI subjects had abnormal MEPs; 53% had abnormal PNTML. All subjects with abnormal PNTML also demonstrated abnormal MEP, but 16/17 subjects with normal PNTML had abnormal MEP. Overall SCI patients had weaker anal sphincters (p<0.05), higher prevalence of dyssynergia (85%) and altered rectal sensation (82%). Conclusions Translumbar and transsacral MEPs revealed significant and hitherto undetected lumbo-sacral neuropathy in 90% of SCI subjects. Test was safe and provided neuropathophysiological information that could explain bowel dysfunction in SCI subjects.

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“…Electrical or magnetic stimulation of the lumbosacral nerve roots facilitates measurements of the conduction time within the cauda equina and diagnosis of sacral motor radiculopathy as a possible cause of fecal incontinence (29). A recent study showed that Translumbar MEP and Transsacral MEP of the rectum and anus provide better delineation of the peripheral neuromuscular injury in subjects with fecal incontinence (30) [Figure 2], and those with spinal cord injury, and is superior to PNTML (31). …”

Section: Investigations Of Fecal Incontinencementioning

confidence: 99%

Advances in Diagnostic Assessment of Fecal Incontinence and Dyssynergic Defecation

Rao¹

2010

Clinical Gastroenterology and Hepatology

127

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Disorders of the anorectum and pelvic floor affect approximately 25% of the population. Their evaluation and treatment have been hindered by a lack of understanding of underlying mechanism (s) and a working knowledge of the diagnostic advances in this field. A meticulous evaluation of anorectal structure and its function can provide invaluable insights to the practicing gastroenterologist regarding the pathogenic mechanism(s) of these disorders. Also, significant new knowledge has emerged over the past decade that include the development of newer diagnostic tools such as high resolution manometry and MR defecography as well as a better delineation of the clinical and pathophysiological subtypes of constipation and incontinence. This article provides an up-to-date review on the role of diagnostic tests in the evaluation of fecal incontinence and constipation with dyssynergic defecation.

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S1826 Translumbar and Transsacral Magnetic Stimulation–a Novel Test of Assessing Anorectal Neuropathy in Fecal Incontinence

Cited by 4 publications

References 0 publications

An Update on Anorectal Disorders for Gastroenterologists

An Update on Anorectal Disorders for Gastroenterologists

Translumbar and Transsacral Motor-Evoked Potentials: A Novel Test for Spino-Anorectal Neuropathy in Spinal Cord Injury

Advances in Diagnostic Assessment of Fecal Incontinence and Dyssynergic Defecation

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