Treatment of Abnormal Rectal Sensation in Cerebrospinal Disease with

Nah, Yong Ho

Abstract

Cerebrospinal disease or injuries frequently result in defecatory difficulty. Management of these patients requires an understanding of the alterations in the mechanisms regulating colorectal function in the cerebrospinal disease. Rectal sensation is usually impaired in cerebrospinal disease and this is one of the pathogenic mechanisms of defecatory difficulty Aim : This study was carried out to evaluate a biofeedback treatment in the patients with impaired rectal sensation after cerebrospinal disease. Subjects : Thirteen patients (5F, 8M, mean age 36 years, range 14~56) with impaired rectal sensation and constipation over 6 months duration developed after brain or spine operation were studied. These included 7 traumatic head injury (5: temporoparietal epidural hematoma, 2: frontal lobe epidural hematoma) and 6 HNP (3: L4~5, 3: L5 ~S1) operation. METHODS: These patients were evaluated by questionnaire, office examination, colon transit studied, anorectal manometry including rectal sensation, balloon expulsion studies, and defecography. All patients underwent biofeedback treatment twice a week for 2 or 3 months. Results : Six brain hematoma and two HNP patients had impaired rectal sensation with anismus and the remaining 5 had only impaired rectal sensation. One brain hematoma (temporoparietal) had anosmia. All patients had normal anal basal pressure, squeeze pressure, rectal compliance, and intact rectoanal inhibitory reflex. Colonic transit time was delayed, but the delay was accounted for by prolonged rectal transit time. The mean volume at which anal relaxation first occurred were 12 ml (range 5~15 ml). The mean threshold volume at which these patients experienced rectal sensation were 90 ml (range 60~130 ml). Biofeedback conditioning in these 13 patients led to normal sensory threshold (mean 20m1, range 10~30 ml) in all patients. Biofeedback also provided spontaneous good passage of stool. Conclusion : Biofeedback treatment appears to be effective in impaired rectal sensation after cerebrospinal operation. Also central neural mechanism may be involved in the pathogenesis of anismus.