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Multiple Sclerosis
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Article

Manometric correlations of anorectal dysfunction and biofeedback outcome in patients with multiple sclerosis

E. Munteis1*, M. Andreu2, J.E. Martinez-Rodriguez1, A. Ois1, F. Bory2, and J. Roquer1

1 Neurology Service, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, IMAS, Barcelona, Spain
2 Digestive Service, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, IMIM, Barcelona, Spain

* To whom correspondence should be addressed.


  Abstract

Objective To evaluate clinical and manometric characteristics of multiple sclerosis (MS) patients with anorectal dysfunction (ARD) and their influence on biofeedback outcome.

Patients and methods Patients were clinically and manometrically studied and compared with controls. Patients were subsequently offered to initiate biofeedback manoeuvres to improve ARD.

Results Fifty-two patients with ARD, 39 women, mean age 44.96±9.26 years, mean Expanded Disability Status Scale 4.13±1.72, were evaluated. Thirty-one patients had relapsing-remitting (RR), 16 secondary progressive and five primary progressive MS. ARD complaints were constipation (67.3%), double ARD (23.1%) and isolated incontinence (9.6%). The manometric study showed significant differences in patients compared with controls in maximal contraction pressures (98.1±44.2 mmHg versus 152.05±66.9 mmHg, P<0.001) and anal inhibitory reflex threshold (92.9±63.4 mL versus 40.45±11.3 mL, P<0.001). Maximal pressure was lower in progressive forms compared with RR forms (83.1±36.2 mmHg versus 108.2±46.7 mmHg, P<0.05) in relation to higher disability. Patients with paradoxical contraction (PC) (35 patients, 67.3%) showed more manometric disturbances. From a total of 18 patients performing biofeedback, those reporting some improvement (six complete, two partial) had milder manometric abnormalities.

Conclusions The most frequent manometric abnormalities in our MS patients with ARD were alterations of maximal pressures, anal inhibitory reflex and PC. Biofeedback could be more useful in patients with lower disability and manometric alterations.

Key Words: anorectal dysfunction; biofeedback; manometry; multiple sclerosis

First published on October 17, 2007, doi:10.1177/1352458507082606

Multiple Sclerosis 2008;14:237.

A more recent version of this article appeared on March 1, 2008

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