Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach

BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark’s Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.

O27 The diameter of an anorectal physiology catheter in the anal canal influences the results

Introduction Conventional “catheter-based” anorectal physiology systems may influence anal canal pressures by stretching the sphincters thereby increasing tension. Anal acoustic reflectometry (AAR) is a “catheter-less” technique as the flexible thin catheter does not distort the anal canal. The aim of this study was to explore whether the size of rigid tube in the anal canal had any effect on tension. Method Participants with no anorectal dysfunction were included. Baseline resting/squeeze AAR measurements were recorded, then repeated with a 6 mm and 10 mm rigid tube placed along-side the AAR catheter. This process was repeated for anorectal manometry (ARM) and Opening pressure (AAR) and mean resting pressure (MRP) were used to calculate tension (pressure (mmHg) x radius (mm)). Result 9 participants were included (7 female/2male) with median age 22 years (21–31 years). Tension at rest (no additional tube) for AAR and ARM was 14 and 135 N/m respectively and 33 and 238 N/m during squeeze. Tension increased in a linear fashion, for both resting and squeeze, as the size of additional rigid tube increased. The largest increase in tension from baseline AAR and ARM measurements was recorded with the 10 mm additional tube (1,807% and 102% respectively). Conclusion The thin AAR catheter exerted the lowest tension at baseline. A large increase in tension was observed as the size of tube increased and therefore the diameter of catheter used in the assessment of anal physiology will affect the results. ARM measurements carried out by devices of different diameter will not be comparable. Take-home Message The diameter of the anorectal physiology catheter in the anal canal influences the results.

Update and review of diagnosing functional anorectal disorders – standardized protocol for high-resolution anorectal manometry and the London classification

Complex anorectal examination including a detailed medical history, physical proctological examination and evaluation of the sensorimotor and structural function of the anorectum is essential for the diagnosis and therapeutic management of functional anorectal dysfunction. The aim of the work is to provide an overview of diagnosing functional anorectal disorders according to the new update and consensus statement of the International Anorectal Physiology Working Group (IAPWG) with a focus on indications, a standardized examination protocol and introduction of the new London classification of anorectal dysfunction. The indications are: fecal incontinence, defecation disorders, functional pelvic (anorectal) pain, evaluation before an anorectal intervention and before planned delivery to assess the function of a previously traumatized anal sphincter. Standardization of the diagnosis and the evaluated data are the basis for multidisciplinary cooperation and determination of a treatment plan for each patient individually.