Rectal Hyposensitivity

Gladman, Marc A.; Scott, Mark; Chan, Christopher L.; Williams, Norman S.; Lunniss, Peter J.

doi:10.1007/s10350-004-6529-x

Cited by 101 publications

(26 citation statements)

References 30 publications

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“…Anorectal physiology studies in MS patients with constipation has been associated with a decrease in rectal compliance, reduced anal and rectal sensation which may reflect a reduced awareness to rectal content and a loss of normal desire to defaecate [26,27]. Other authors have described an obstructive defaecatory picture with the failure of the sphincters to relax -anismus [20].…”

Section: Physiology Of the Anorectummentioning

confidence: 99%

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

Thiruppathy¹,

Preziosi²

2014

J Neurol Neurophysiol

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Bowel dysfunction amongst multiple sclerosis (MS) patients often manifests as faecal incontinence (FI), constipation, or a combination of the two. Its pathophysiology is poorly understood and can be multifactorial. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice. Due to the varied and fluctuant nature of the symptoms, these patients can be a management challenge. This review aims to give an overview of the pathophysiology, clinical manifestations and the principles of management of multiple sclerosis patients with bowel dysfunction.

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Section: Physiology Of the Anorectummentioning

confidence: 99%

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

Thiruppathy¹,

Preziosi²

2014

J Neurol Neurophysiol

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“…Studies have also shown that patients with multiple sclerosis and diabetes have higher rectal sensory thresholds30-32 than healthy individuals. In the absence of confirmed neurological dysfunction, RH is present in 23% of adult patients with constipation, 10% of patients with fecal incontinence (FI) and 27% of patients in whom these symptoms co-existent17; nevertheless, up to 63% of such individuals give a history that includes factors that could potentially disrupt the afferent pathway,33 suggesting this may be the primary pathogenic mechanism. By way of example, in the largest published series of patients with RH to date, 38% had undergone prior pelvic surgery, 22% anal surgery and 13% described prior spinal trauma 33.…”

Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

“…More recent work has shown that blunted sensation to rectal distension occurs in almost a quarter of adult patients with chronic idiopathic constipation,11-13 and in up to two-thirds of idiopathic pediatric constipation 14-16. It is also found in 10% of patients with fecal incontinence 17. Despite occurring frequently, and often as the only discernible physiological abnormality,17 little is known as to its pathogenesis or true clinical impact.…”

Section: Introductionmentioning

confidence: 99%

“…It is also found in 10% of patients with fecal incontinence 17. Despite occurring frequently, and often as the only discernible physiological abnormality,17 little is known as to its pathogenesis or true clinical impact. This review will consider contemporary understanding of rectal hyposensitivity, particularly with reference to patients with intractable constipation.…”

Section: Introductionmentioning

confidence: 99%

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Rectal Hyposensitivity

Burgell¹,

Scott²

2012

J Neurogastroenterol Motil

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Impaired or blunted rectal sensation, termed rectal hyposensitivity (RH), which is defined clinically as elevated sensory thresholds to rectal balloon distension, is associated with disorders of hindgut function, characterised primarily by symptoms of constipation and fecal incontinence. However, its role in symptom generation and the pathogenetic mechanisms underlying the sensory dysfunction remain incompletely understood, although there is evidence that RH may be due to 'primary' disruption of the afferent pathway, 'secondary' to abnormal rectal biomechanics, or to both. Nevertheless, correction of RH by various interventions (behavioural, neuromodulation, surgical) is associated with, and may be responsible for, symptomatic improvement. This review provides a contemporary overview of RH, focusing on diagnosis, clinical associations, pathophysiology, and treatment paradigms.

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“…Obstructed defecation patients have a significantly higher rectal sensitivity threshold than controls. The relationship between rectal hyposensitivity and pelvic floor dyssynergia suggests a causative relation of the two, possibly from blunting of the urge to defecate in patients with rectal hyposensitivity [7]. This first complex mechanism is amplified and maintained as the beginning of descending perineum: excessive abdominal straining at stool evacuation, induced by pelvic floor dyssynergia and rectal hyposensitivity as stated above, has been identified as the cause of progressive perineal descent with relevant negative influence on the pelvic fascia and pelvic muscles.…”

mentioning

confidence: 93%

A theory of progression from obstructed defecation to fecal incontinence

Pucciani

2015

Tech Coloproctol

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Fecal disorders have a relevant social impact because they impair the quality of life of the patient and add to the cost of healthcare. In order to shed light on the pathophysiology of fecal disorders it is helpful to consider the progression of obstructed defecation to fecal incontinence which occurs in women without anal sphincter defects who have descending perineum syndrome.The overall prevalence of chronic constipation in the general population is about 15 %, and the most common subtype among women is obstructed defecation. Obstructed defecation occurs in 47.7 % of Italian patients affected by chronic constipation. Dyssynergia alone is present in young women (median age 38 ± 14 years), whereas dyssynergia plus structural diseases, such as rectocele, rectal intussusception, mucosal prolapse and perineal descent materialize in middle-aged women (median age 52 ± 14 years) [1]. Therefore there is no doubt that ageing is implicated in the evolution from functional to anatomic pelvic floor disorders. In parallel, excessive abdominal straining at stool evacuation causes progressive perineal descent: the recurrent straining against defecatory outlet obstruction impairs pelvic floor muscle tone until it disappears completely. In this way descending perineum overlaps with pelvic floor dyssynergia [2]. Older age is correlated with both dynamic and fixed descending perineum [3], and excessive perineal descent is found in 78 % of elderly patients with evacuation disorders [4]. The organic descent of the hypotonic pelvic floor combined with pudendal neuropathy explains the appearance of fecal incontinence. Perineal descent involves the anterior, middle and posterior pelviperineal areas in women. Uro-gynecological structures and proctologic segments are all implicated and thus pelvic organ prolapse may coexist with rectoanal intussusception, rectal prolapse and rectocele [5].Fecal incontinence is a physically and psychologically disabling condition which has a negative impact on the quality of life of the patient. The prevalence of fecal incontinence in community-dwelling women in the USA varies considerably depending on the population studied, ranging from 2.2 to 17 % of women housed in communities and up to almost half of all nursing home residents. Fecal incontinence is often related to several specific diseases, such as diabetes mellitus, dementia, irritable bowel syndrome, cerebrovascular disease, pelvic-anal surgery, traumatic sphincter lesions and post-partum incontinence. Even when excluding the presence of these cases, women over 65 years often have combined chronic constipation and fecal incontinence (32.7 % of constipated women) and women with anal incontinence have greater values of descending perineum measures than those without anal incontinence [6]. Therefore, these last epidemiological data support the hypothesis of a link between obstructed and fecal incontinence via descending perineum syndrome.Obstructed defecation can be caused by organic or functional diseases which are difficult to untangle. Mechanic...

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Rectal Hyposensitivity

Cited by 101 publications

References 30 publications

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

Multiple Sclerosis Related Bowel Dysfunction: Pathophysiology, Clinical Manifestation and Management

Rectal Hyposensitivity

A theory of progression from obstructed defecation to fecal incontinence

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