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Cited by 18Pelvic floor disorders treatmentsGastrointestinal motility and disordersUrinary Bladder and Prostate Research

Anal sphincter dysfunction in multiple sclerosis: an observation manometric study

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Marola, Silvia, Ferrarese, Alessia, Gibin, Enrico, Capobianco, Marco, Bertolotto, Antonio, Enrico, Stefano, Solej, Mario, Martino, Valter +2 more·2016·Open Medicine
DOI 10.1515/med-2016-0088PMC PMC5329875
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Abstract

Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis. 136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient. RESULTS: Group A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively). CONCLUSIONS: The decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy.

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  • In multiple sclerosis, both slow transit and defecatory dyssynergia contribute to bowel symptoms.

    “Objective studies using anorectal manometry, transit testing, and validated symptom instruments demonstrate that both slow transit and defecatory dyssynergia contribute to symptoms in MS, with severity often tracking neurologic disability (Almeida et al., 2019; Lin et al., 2019; Marola et al., 2016; Preziosi et al., 2014; Weber et al., 1987; Wiesel et al., 2000).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Marola et al., 2016

    The Introduction (page not available) reports slower colonic transit in MS and discusses dyschezia as a contributor to constipation. It presents pelvic-floor dyssynergia as a hypothesis and says paradoxical puborectalis contraction may partly explain obstructed defecation; the claim states that contribution more definitively than the source does. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In multiple sclerosis, bowel symptom severity often tracks neurologic disability.

    “Objective studies using anorectal manometry, transit testing, and validated symptom instruments demonstrate that both slow transit and defecatory dyssynergia contribute to symptoms in MS, with severity often tracking neurologic disability (Almeida et al., 2019; Lin et al., 2019; Marola et al., 2016; Preziosi et al., 2014; Weber et al., 1987; Wiesel et al., 2000).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Marola et al., 2016

    The Methods (Variables; page unavailable) say the study measured EDSS disability and bowel-symptom scores, but our copy does not report whether symptom severity tracked EDSS. The Discussion (Difference in resting anal pressure; page unavailable) instead compares EDSS with a manometric measure and finds no statistically significant difference; that does not settle the symptom-severity claim. (LLM, conf=0.72)

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References 28 · Cited by 18

Research works printed but not linked: 28

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Authors
Marola, S., Ferrarese, A., Gibin, E., Capobianco, M., Bertolotto, A., Enrico, S., Solej, M., Martino, V., Destefano, I., & Nano, M.
Affiliations
Ospedale San Luigi Gonzaga (IT)
Corresponding author
Ferrarese, Alessia
ORCID
Venue
Open Medicine
Publisher
Walter de Gruyter GmbH
Published
2016-01-01
Volume
11
Issue
1
Pages
509-517
ISSN
  • 1895-1058 (ISSN-L)
  • 2391-5463
DOI
10.1515/med-2016-0088
PMC
PMC5329875
OpenAlex
W2556749208
Cited by
18
References
28
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 1 · 2019: 4
FWCI
1.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Open Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Keywords
multiple sclerosis, anorectal manometry, anal sphincter dysfunction, constipation, fecal incontinence, obstructed defecation, anal resting pressure, squeeze pressure, rectoanal inhibitory reflex

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