Anorectal Dysfunction in Multiple Sclerosis: A Systematic Review

Table 1

Mechanisms of anorectal dysfunction.

Assessment tool	Symptom	Sample size	MS severity	Results	Reference
Anorectal manometry	Con	21	EDDS: 5.3	Decreased rectoanal inhibitory reflex	[23]
	Con or FI	39	EDSS: 5	No difference based on symptom patterns	[22]
			DSS ≤5: 5
	Con	13	DSS ≥5: 8	Weak external sphincter: 62%; impaired straining: 82%	[11]
	Con	30	EDSS: 6	Lower squeeze pressure, impaired valsalva pressures	[12]
	Con and FI	11		Lower sphincter pressures in women	[35]
	Con and FI	23	Wheelchair: 9	Abnormal squeeze pressure in a subset	[36]
	Con and FI	16		Impaired amplitude and duration of squeeze pressure	[19]
	Con and FI	52	EDSS: 4.13	Decreased squeeze pressures	[16]
	FI	6		Markedly reduced squeeze pressure	[32]
	FI	12		Lower squeeze pressure in women only after childbirth	[27]
	Con	9	EDSS: 9.6	Decreased squeeze pressure	[13]
Recto-anal sensitivity	Con and FI	39	EDSS: 5	No differences in rectal or anal sensory thresholds	[22]
	Con and FI	11		Normal rectal sensory thresholds	[35]
	FI	5		Abnormal sensory threshold to distension in 3/5 patients	[19]
	Con	9	EDSS: 9.6	Normal rectal and anal sensory thresholds	[13]
	FI	6		Normal rectal sensory thresholds	[32]
	Con and FI	52	EDSS: 4.13	Normal rectal sensory thresholds	[16]
	Con and FI	30	EDSS: 6	Abnormal sensory threshold to distension in 15 patients	[12]

Con: constipation; FI: fecal incontinence; EDSS: expanded disability status scale.