Abstract
<h3>To the Editor:—</h3> Is there really a "recto-cerebral reflex," as many of us have been taught? Is it really dangerous to distend manually the rectal sphincter of a patient with raised intracranial pressure for fear of causing an even further rise? No one will ever know how many rectal carcinomas have gone undetected (oft times when their detection would have helped to clarify the possibly metastatic cause of the raised intracranial pressure) or how much human suffering has been prolonged by the possibly unnecessary withholding of manual fecal disimpaction. Certainly the dangers of administering enemas to patients with raised intracranial pressure are well documented and are well known to physicians and nurses alike.<sup>1,2</sup>Distending the colon with fluid compresses abdominal veins and raises their intraluminal pressure. This pressure is in turn transmitted via paravertebral veins to the intrathecal space, causing a sharp rise in intracranial pressure. Manually compressing the
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