Usefulness of Anorectal Manometry in Patients with Spinal Cord Injury

Kim, Dong Uk; Song, Geun Am; Kim, Gwang Ha; Heo, Jeong

Abstract

BACKGROUND/AIMS: To evaluate the characteristics of anorectal manometry based on the level of spinal cord injury (SCI) in patients with neurogenic bowel.
METHODS
Twenty five patients with SCI were classified as complete or incomplete lesions according to severity, and > or = T5 or < or = T6 SCI according to the level of injury. We measured the maximum anal resting pressure (MARP), maximum squeezing pressure (MSP), threshold of rectoanal inhibitory reflex (RAIR), rectal sensations, and intraluminal pressure changes while patients were bearing down.
RESULTS
In patients with SCI the MARP, MSP, and RAIR were: 77.8+/-41.9 mmHg, 92.4+/-53.5 mmHg, and 26.0+/-14.1 mL respectively. In patients with complete lesions, the MSP/MARP and minimal volume for the RAIR were lower than in the patients with incomplete lesions (p=0.030, p=0.039 respectively). Rectal sensations were affected more frequently and completely in patients with complete lesions than in patients with incomplete lesions. Bearing down in patients with > or = T5 SCI was associated with a higher percentage of decreased anal relaxation than in those patients with < or = T6 SCI (- 1.7+/-25.8 mmHg and 22.7+/-18.4% respectively).
CONCLUSIONS
Patients with SCI had abnormal findings on anorectal manommetry. Patients with complete lesions had decreased voluntary contractions of the external anal sphincter resulting in fecal incontinence. In addition, patients with > or = T5 SCI had paradoxical contractions or inadequate relaxation of the internal anal sphincter when bearing down resulting in more severe constipation.