Pelvic floor function in patients with clinically complete spinal cord injury and its relation to constipation

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Abstract
Means of colonic transit time, anal manometry, electrophysiologic testing, and sensory-evoked potentials. RESULTS: Sixteen patients had prolonged total and segmental colonic transit times (Group C), and nine patients had normal colonic transit times (Group NC). Basal pressure and anal pressure during coughing, Valsalva's maneuver, and rectal distention were diminished in all patients, but no differences were observed between Group C and Group NC. Rectal sensation was preserved in eight patients, but this was not related to the absence of constipation. In seven of these eight patients, somatosensory-evoked potentials could be recorded, which indicated an incomplete cord lesion. Synergic relaxation of the pelvic floor during straining was never observed; dyssynergia was seen in ten (7 in Group C and 3 in Group NC; P = not significant) patients. Associated peripheral nerve damage was present in 40 percent of patients but did not predispose these patients to constipation. CONCLUSIONS: Loss of rectal sensation, dyssynergic pelvic floor contraction during straining, associated peripheral nerve damage, and insufficient rise of intra-abdominal pressure could not be held responsible for constipation as a result of spinal cord injury. A prolongation of the colonic transit time is the most important mechanism, and therapy should be directed toward it. Supported by a grant from the Flemish Society of Gastroenterology 1994 and awarded the 1996 Nationaal Fonds voor Wetenschappelijk Onderzoek Prize. Presented in part at the annual meetings of the American Gastroenterological Association in New Orleans, Louisiana, May 15 to 18, 1994, and San Francisco, California, May 19 to 22, 1996, and published in abstract form (Gastroenterology 1994; 106:A485 and Gastroenterology 1996;107:A655). © The ASCRS 1998...