Anal Sphincter Pressure Research Articles

Application of Anal Manometry in the Planning for Anal Fistula Surgery

Anal fistula does not heal spontaneously without surgery, and anal function should be preserved after muscle dissection, which is a challenge even to the most experienced surgeon. In order to develop a planner for anal fistula surgery, anal manometry used in the measurement of pressures in the anal canal to investigate the anal function is reviewed. In this review paper, current techniques are described and compared with each other, and technical and clinical challenges are discussed. There are four types of catheters used to measure anal sphincter pressure: water-perfused, solid-state, air-coupled, and fiber optic catheter. Parameters acquired by anal manometry and their relationship with fecal incontinence after anal fistula surgery are discussed. Vectormanometry can provide the pressure profile along the anal canal in three dimensional space, pressure vectorgram, and cross-sectional radial asymmetry, which have more advantages than the conventional method. Understanding the technology and development of anal manometry is critical for the anal fistula surgical planning. A novel design is highly desired for 3D pressure profile measurement along the entire anal canal simultaneously without pulling the catheter.

Is chemodenervation with incobotulinumtoxinA an alternative to invasive chronic anal fissure treatments?

BackgroundBotulinum toxin type A is currently strongly recommended for the treatment of anal fissures (AFs). However, there is still no consensus on dosage or injection technique. This study provides further efficacy and safety evidence in a 2-year follow-up.MethodProspective, open-label, single-arm, single-center study carried out in adult patients with AFs non-responsive to previous treatments. Patients were treated with incobotulinumtoxinA (incoBoNT/A) injected in both laterals and posterior intersphincteric groove. Healing rate at 2 years was the primary endpoint. Secondary endpoints included internal anal sphincter pressures, incontinence, and safety.ResultsA total of 49 patients were treated with a mean incoBoNT/A dose of 40.5 U (spread across three locations). Healing rate at 2 years was 83.9% with a 24.5% of recurrence throughout the study. Only 7 patients (14.3%) reported adverse events (AEs) that were mild and temporary. Mean reduction in anal resting pressure was -9.1 mmHg at 3 months (p = 0.001). Mean reduction in voluntary squeeze pressure was -27.5 mmHg at 3 months (p < 0.001). Mean pain perception measured with a visual analog scale decreased by -6.5 points at 2 years (p < 0.001). There was an incontinence increase at 1 month of 1.3 points (p = 0.006), but baseline values were restored at 6 months.ConclusionWe present results that support the use of incoBoNT/A as a second line for AFs that do not respond to ointment therapy. IncoBoNT/A injection is a less invasive treatment that should be considered before surgery due to its efficacy and its safety which includes no permanent impairment.Trial registrationISRCTN90354265; Registered on 16th February 2024. Retrospectively registered.

Effect of reboxetine and citalopram on anal opening pressure in healthy women: A randomized, double-blind, placebo-controlled crossover study.

In placebo-controlled clinical trials, reboxetine, a selective noradrenaline reuptake inhibitor, increases urethral pressure and relieves stress urinary incontinence symptoms in women. Considering the close connection in neural regulation of the external urethral and anal sphincters, we hypothesized that reboxetine may also enhance anal sphincter pressure. Conversely, it is believed that selective serotonin reuptake inhibitors may contribute to fecal incontinence by reducing anal sphincter pressure. In this study, we investigated the effect of reboxetine and citalopram on anal opening pressure in healthy female volunteers. In a double-blind, three-way crossover trial, 24 female participants received single doses of 40 mg citalopram, 8 mg reboxetine, and matching placebos, with a minimum of 8-day washout between sessions. Using anal acoustic reflectometry, we measured anal opening pressure during both resting and squeezing conditions at the estimated time of peak plasma concentration for both study drugs. Compared with placebo, reboxetine increased anal opening pressure with 23.4 cmH2O (95% confidence interval [CI] 16.5-30.2, p < 0.001) during rest and with 22.5 cmH2O (95% CI 15.2-29.8, p < 0.001) during squeeze. Citalopram did not change anal opening pressure statistically significantly compared to placebo. An 8-mg dose of reboxetine increased anal opening pressure substantially in healthy women, suggesting potential benefits for fecal incontinence symptoms. In contrast, a 40-mg dose of citalopram showed a marginal and statistically insignificant effect on anal opening pressure, indicating that selective serotonin reuptake inhibitors do not contribute to fecal incontinence by reducing anal sphincter tone.

Relation between the internal anal sphincter and defecation disorders in patients with anorectal malformations.

To investigate associations between the rectoanal inhibitory reflex (RAIR), type of congenital anorectal malformations (ARMs), type of operation that patients with ARM had undergone, and objectively measured fecal incontinence and defecation problems. We retrospectively included 69 pediatric patients with ARM. All underwent anorectal function tests at the University Medical Center of Groningen during the last 10 years. We assessed anorectal physiology using the Rome IV criteria and anorectal function tests. We found the reflex in 67% of patients and all types of ARMs. All patients who had not been operated on, and those who had undergone less extensive surgery possessed the reflex. In contrast, patients who underwent posterior sagittal anorectoplasty, 44% possessed it. We found no difference between mean rectal volumes in patients with and without the reflex (251 vs. 325 mL, respectively, p = 0.266). We found that over time, patients without the reflex seemed to develop significantly higher rectal volumes than patients who had it. We did not find a significant difference between the reflex and fecal incontinence; however, it seems that the absence of the reflex, resting anal sphincter pressure, and fecal incontinence are related. The RAIR seems present in patients with ARM irrespective of their malformation type. Corrective surgery, however, may impair this reflex. Seemingly, its absence results in constipation with enlarged rectal volumes and fecal incontinence. Every effort should be made to preserve this reflex during surgery and to use extensive surgical procedures as sparingly as possible.

Anorectal function and symptoms 6 months after robot-assisted laparoscopic radical prostatectomy: a single-center study.

Robot-assisted laparoscopic radical prostatectomy (RALP) is a common procedure for the treatment of localised prostate cancer. Anorectal symptoms such as fecal incontinence (FI), rectal urgency or disturbed defecation have been reported after the operation. Anorectal function is dependent on the integrity of anal and pelvic nerves and muscles, rectal sensory function as well as rectal reservoir function. The aim of this study was to investigate the potential influence of RALP on anorectal physiological function and bowel symptoms. In this pilot study, 29 patients with localised prostate cancer scheduled for RALP were included. Anorectal physiology was used to measure rectal sensitivity and reservoir function as well as anal sphincter pressures. Bowel symptoms were measured by a bowel function questionnaire and a 2-week bowel function diary. Measurements were done before the operation and repeated at 6 months after the operation. The study observed a significant postoperative increase in rectal sensory threshold for rectal balloon distention, from 20 to 40 mmHg, P < 0.001. This change is indicative of a decrease in rectal sensation after RALP. There were no other statistical significant differences in any of the physiological tests performed. Importantly, there was no change in any of the bowel symptoms after surgery. This study showed that RALP may lead to impaired rectal sensory function. This finding did not, however, seem to have any influence on the patients´ postoperative clinical bowel function.

Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation.

In pilot work, we showed that somatic nerve transfers can restore motor function in long-term decentralized dogs. We continue to explore the effectiveness of motor reinnervation in 30 female dogs. After anesthesia, 12 underwent bilateral transection of coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. Twelve months postdecentralization, eight underwent transfer of obturator nerve branches to pelvic nerve vesical branches, and sciatic nerve branches to pudendal nerves, followed by 10 mo recovery (ObNT-ScNT Reinn). The remaining four were euthanized 18 mo postdecentralization (Decentralized). Results were compared with 18 Controls. Squat-and-void postures were tracked during awake cystometry. None showed squat-and-void postures during the decentralization phase. Seven of eight ObNT-ScNT Reinn began showing such postures by 6 mo postreinnervation; one showed a return of defecation postures. Retrograde dyes were injected into the bladder and urethra 3 wk before euthanasia, at which point, roots and transferred nerves were electrically stimulated to evaluate motor function. Upon L2-L6 root stimulation, five of eight ObNT-ScNT Reinn showed elevated detrusor pressure and four showed elevated urethral pressure, compared with L7-S3 root stimulation. After stimulation of sciatic-to-pudendal transferred nerves, three of eight ObNT-ScNT Reinn showed elevated urethral pressure; all showed elevated anal sphincter pressure. Retrogradely labeled neurons were observed in L2-L6 ventral horns (in laminae VI, VIII, and IX) of ObNT-ScNT Reinn versus Controls in which labeled neurons were observed in L7-S3 ventral horns (in lamina VII). This data supports the use of nerve transfer techniques for the restoration of bladder function.NEW & NOTEWORTHY This data supports the use of nerve transfer techniques for the restoration of bladder function.

Botulinum toxin injection for chronic anal fissure: a prospective controlled study with long follow-up.

Botulinum toxin is an effective therapeutic option for chronic anal fissure. However, there is no evidence about treatment standardization and long-term follow-up. We aimed to evaluate the short- and long-term efficacy and safety of botulinum toxin compared to close lateral internal sphincterotomy, with a 5-year follow-up. This was a prospective, controlled, single-center study conducted at University Hospital of Ferrara, Ferrara, Italy. The primary outcome was fissure healing at 1 month. Secondary outcomes were Quality-of-Life (QoL) at 1 month and after 5 years, and fissure recurrence at 6 months and 5 years. A total of 59 patients received botulinum toxin injection (Botox), and 32 underwent lateral internal sphincterotomy. At 1 month after treatments, postoperative pain decreased faster and significantly more in the Botox group (30 vs. 60 mm; P<0.001); fissure re-epithelization was observed in 59.4% of the surgical group compared to 25.4% of Botox (P=0.0001). Anal sphincter pressures decreased more in surgical group (P=0.044), although severe anal incontinence was present only in this subset (6.2%; P=0.041). Compared to surgery, patients who received Botox had higher satisfaction rates (P<0.001). Fissure recurrence at 6 months was more common in Botox than surgical group (16.9% vs. 3.2%, respectively; P=0.053). The overall healing rate improved in all patients and persisted at 12 months and 5 years in both groups with overall high patient satisfaction despite mild anal incontinence in 21.8% in the surgery group (P<0.05). Botox, rather than surgery, should be considered the first-line treatment for chronic anal fissure.

Surgical effect and gastrointestinal functional recovery of laparoscopic-guided total mesorectal excision in patients with rectal cancer.

To explore the surgical effect and gastrointestinal functional recovery of laparoscopic-guided total mesorectal excision (LGTME) in patients with rectal cancer. A total of 150 rectal cancer patients who underwent surgical treatment in our hospital from July 2022 to July 2023 were selected and randomly divided into two groups using a random number table. There were 75 cases in the control group (CG) who underwent traditional open rectal total mesorectal excision surgery and 75 cases in the experimental group (EG) who underwent LGTME. The surgical effects of the two groups were compared, and the gastrointestinal and anal functional recovery of the two groups were compared before and after treatment. Intraoperative bleeding, incision length, time to initial feeding and time to anal exhaust in the EG were significantly lower than those in the CG ( P < 0.05). Before treatment, there was no significant difference in gastrointestinal function and anal function between the two groups ( P > 0.05). After treatment, the levels of motilin, gastrin, neuropeptide Y and basic fibroblast growth factor in the EG were significantly higher than those in the CG, with statistical significance ( P < 0.05); the maximum anal systolic pressure and resting anal sphincter pressure in the EG were significantly lower than those in the CG ( P < 0.05); the rectal sensitivity threshold volume (RSTV) and rectal maximum volume threshold in the EG were significantly higher than those in the CG ( P < 0.05). There was no significant difference in most postoperative complications between the two groups ( P > 0.05). LGTME improves the surgical effects of rectal cancer patients, promotes the recovery of gastrointestinal function and has a small effect on anal function indicators, thereby reducing hospital stay.

Therapeutic potential and mechanisms of sacral nerve stimulation for gastrointestinal diseases.

The aim of this systemtic review is to introduce clinical applications (especially emerging) and potential mechanisms of sacral nerve stimulation (SNS) for treating various gastrointestinal diseases. PubMed and Web of Science were searched for studies published on SNS and its clinical applications in fecal incontinence (limited to systematic review and meta-analysis of clinical studies), constipation (limited to reviews and randomized control clinical studies), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and upper gastrointestinal motility disorders. The relevant studies were pooled, and their findings were summarized and discussed. SNS is an approved method for treating fecal incontinence. Systematic review and meta-analysis demonstrated high efficacy of the SNS therapy for fecal incontinence. Increased anal sphincter pressure and improvement in rectal sensation were reported as major mechanisms involved in the SNS therapy. SNS has also been proposed for treating constipation, but the therapy has been shown ineffective. There is a lack in SNS methodological optimization and mechanistic research. A few basic and clinical studies have reported the potential of SNS for treating visceral pain in IBS. SNS seemed capable of improving mucosal barrier functions. Several case reports are available in the literature on the treatment of IBD with SNS. Several laboratory studies suggested therapeutic potential of a special method of SNS for IBD. Cholinergic anti-inflammatory mechanisms were reported. Due to a recently reported spinal afferent and vagal efferent pathway of SNS, a few preclinical studies reported the potential of SNS for upper gastrointestinal motility disorders. However, no clinical studies have been performed. SNS for fecal incontinence is a well-established clinical therapy. However, the current method of SNS is ineffective for treating constipation. Further methodological development and randomized clinical trials are needed to explore potential applications of SNS for IBS and IBD.

EFFICACY OF TOPICAL DILTIAZEM COMBINED WITH LOCAL XYLOCAINE TO DECREASE THE PAIN DURING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

Transrectal Ultrasound Guided Biopsy (TRUS) has been the gold standard in the detection of prostate cancer. The cancer detection rate is higher in biopsy protocols taking more core needles. The periprostatic nerve block (PPNB) has become most widely accepted form of anaesthesia for performing TRUS biopsy*1, but PPNB does not reduce the pain during the insertion of rectal ultrasound probe. The act of probe insertion was described as most uncomfortable in a randomized trial of pain perception during TRUS guided biopsy.*2 Calcium channel blockers like diltiazem cream acts by blocking the slow calcium channel located in the anal sphincter bro muscular cell membranes to achieve smooth muscle relaxation, and hence reduce the resting anal sphincter pressure

A possible physiological mechanism of rectocele formation in women

BackgroundWe aimed to determine the anorectal physiological factors associated with rectocele formation.MethodsFemale patients (N = 32) with severe constipation, fecal incontinence, or suspicion of rectocele, who had undergone magnetic resonance defecography and anorectal function tests between 2015 and 2021, were retrospectively included for analysis. The anorectal function tests were used to measure pressure in the anorectum during defecation. Rectocele characteristics and pelvic floor anatomy were determined with magnetic resonance defecography. Constipation severity was determined with the Agachan score. Information regarding constipation-related symptoms was collected.ResultsMean rectocele size during defecation was 2.14 ± 0.88 cm. During defecation, the mean anal sphincter pressure just before defecation was 123.70 ± 67.37 mm Hg and was associated with rectocele size (P = 0.041). The Agachan constipation score was moderately correlated with anal sphincter pressure just before defecation (r = 0.465, P = 0.022), but not with rectocele size (r = 0.276, P = 0.191). During defecation, increased anal sphincter pressure just before defecation correlated moderately and positively with straining maneuvers (r = 0.539, P = 0.007) and defecation blockage (r = 0.532, P = 0.007). Rectocele size correlated moderately and positively with the distance between the pubococcygeal line and perineum (r = 0.446, P = 0.011).ConclusionIncreased anal sphincter pressure just before defecation is correlated with the rectocele size. Based on these results, it seems important to first treat the increased anal canal pressure before considering surgical rectocele repair to enhance patient outcomes.Graphical abstract

Parasympathetic control of gastrointestinal motility and cross-branch actions of parasympathetic neuromodulation.

Parasympathetic control of gastrointestinal motility and cross-branch actions of parasympathetic neuromodulation.

Does surgical treatment for complicated pilonidal cyst disease in the sacral region affect anal sphincter functions

<br><b>Introduction:</b> Pilonidal cyst disease is characterized by chronic abscess, discharge, and sinus openings. The anal sphincter functions of the patients, who previously undergone recurrent surgical treatment, were compared using a surgical approach. Patients were divided into two groups by whether perianal soft tissues were preserved in the surgery. <b>Materials and Methods:</b> Between 2014 and 2019, 21 male patients who had either undergone insufficient surgery or had complications with multiple sinus openings applied to our clinic. Excision and reconstruction of the patients were performed. The coccyx, dorsal part of sacrum, anococcygeal raphe, and ischiorectal fossa were additionally included in the excision for patients with biopsy reports of squamous cell carcinoma. All patients underwent rectoanal manometry to evaluate anal sphincter function. Preoperative, postoperative 5^th week, and 6^th-month anal manometry results were recorded and analyzed by the Shapiro − Wilk test and independent <i>t</i>-test. <b>Results:</b> The anal sphincter function regresses in the 5^th week after the reconstruction and improves in the 6 month. The results of the independent <i>t</i>-test, which were used to compare the anal manometry results for each group, showed that the difference in the anal sphincter pressure of the two groups was statistically significant (<i>P</i> < 0.05). If the perianal soft tissues were excised, anal sphincter manometry shows poor results. <b>Discussion:</b> The anal sphincter function, which regresses in the 5^th week after the reconstruction and improves in the 6 months, depends on the scar tissue occurring in the perianal connective tissue, while the softening caused by the maturation of the scar in the last phase of wound healing improves the function.<br>

L-Arginine is a feasible supplement to heal chronic anal fissure via reducing internal anal sphincter pressure: a randomized clinical trial study.

The hypertonicity of internal anal sphincter resting pressure is one of the main causes of chronic anal fissure. Therefore, the aim of this study was to assess the effect of oral administration of L-arginine on the improvement of the anal fissures by relaxing the internal anal sphincter. Seventy-six chronic anal fissure patients (aged 18-65years) who were referred to Rasoul-e-Akram Hospital, Tehran, Iran from February 2019 to October 2020 participated in this randomized, double-blind, placebo-controlled trial. Participants were allocated into treatment (L-arginine) and placebo groups. They took a 1000mg capsule three times a day for 1 month, and then we followed them at the end of the first and third months after the intervention. Clinical symptoms, anal sphincter resting pressure, and quality of life (QoL) were completed at baseline and the end of the study. The analysis of data showed a significant decrease in bleeding, fissure size, and pain for each group; however, in the L-arginine group was more than the control group at the end of the study (P values < 0.001). Following that, a significant increase in QoL was seen just in patients treated with L-arginine (P value = 0.006). In addition, the comparison of anal pressures at baseline and, between groups at the end of the study showed a significant reduction in sphincter pressure in patients treated with L-arginine (P value < 0.001, = 0.049; respectively). The oral administration of 3000mg L-arginine can heal chronic anal fissures by reducing internal anal sphincter pressure with more negligible side effects. However, we recommend long-term study with more extended follow-up.Clinical trial registry: IRCT20190712044182N1 at Iranian clinical trials, date: 2019-08-27.

Characteristics of Fecal Incontinence in Male Patients in Japan.

Although community studies have shown no difference between the sexes in the prevalence of fecal incontinence (FI), few direct comparisons of disease characteristics between male and female patients have been reported. The aim of this study was to determine whether characteristics of FI differ between male and female patients in Japan. Included in the study were 408 (149 men, 259 women) patients with FI who visited the Matsushima Hospital Coloproctology Center between October 2016 and September 2017. We retrospectively evaluated data on age, number of bowel movements, Bristol stool form scale, number of FI, incontinence scores, anorectal manometry, comorbidities, and history of anal surgery. Maximum resting pressure and maximum squeeze pressure were found to be within normal range in significantly more male than female patients (34.9% vs. 12.4%, respectively; p < 0.0001). Irritable bowel syndrome (IBS, 20.1% vs. 9.3%; p = 0.003) and a history of anal surgery (29.5% vs. 17.5%; p = 0.02) were more prevalent among male patients than among female patients. Use of mepenzolate as treatment was significantly more common among male patients than among female patients (16.8% vs. 6.6%, respectively; p = 0.005). Responses to the various treatments were good, regardless of sex. FI appears to be more commonly accompanied by normal anal sphincter pressures in male patients than in female patients, and IBS and previous anal surgery appear to be more common among male patients than among female patients. FI appears to be controllable in most patients, regardless of sex.

Campsiandra laurifolia Reduces Oxidative Stress and Inflammation in Rats with Ulcerative Colitis

AbstractUlcerative colitis (UC) affects the mucosa and submucosa of the large intestine. One of the mechanisms involved in its etiology is oxidative stress (OS), directly involved in the inflammatory process characteristic of UC. The Campsiandra laurifolia, known as acapurana, was described as possessing antioxidant properties. We used 24 male Wistar rats, divided into control (CO), control + acapurana (CO + A), colitis (CL), and colitis + acapurana (CL + A) groups. This study performed histological analysis, measuring anal sphincter pressure (ASP) and lipoperoxidation (LPO). The activity of the antioxidant enzyme superoxide dismutase (SOD) and glutathione (GSH) levels were evaluated. The expression of the nuclear factor kappa B (NFκB) and inducible nitric oxide synthase (iNOS) was analyzed by immunohistochemistry. The statistical analysis used was the one-way analysis of variance (ANOVA), followed by the Student-Newman-Keuls test; values were expressed as mean ± standard error, and the significance level was p &lt; 0.05. In the animals of the CL group, we observed the destruction of the crypts and the presence of mucosal ulcers, edema, and submucosal inflammatory infiltrate, as well as increased damage to the intestinal mucosa, reduced ASP, increased LPO and SOD activity, reduced GSH levels, and increased expression of NFκB and iNOS. The administration of C. laurifolia in the CL + A group was shown to cause regeneration of crypts, reduction of inflammatory infiltrate, reduction of damage to the intestinal mucosa, increase in ASP, and reduction in LPO with the restoration of SOD activity and GSH levels. The immunohistochemistry of NFκB and iNOS was significantly reduced. Therefore, the C. laurifolia aqueous extract appears to exert an antioxidant and anti-inflammatory effect in rats with AA-induced colitis.

Intra- and inter-observer agreement in the classification of dyssynergic defecation on high-resolution anorectal manometry using water-perfusion system

Dyssynergic defecation (DD) classified on anorectal manometry is based on variations in anal sphincter pressures and rectal pressure generated during bearing down. There is a paucity of data on intra- and inter-observer agreement in the classification of DD on high-resolution anorectal manometry (HRAM) using a water-perfusion system. This cross-sectional observational study was conducted between June 2014 and May 2016 on 70 adult patients with DD. Observer 1 did the baseline analysis and reanalyzed the readings at least 6 months later, blinded to the initial analysis results (intra-observer variability). Four other blinded observers (5-25 years in anorectal manometry and minimum 5 years of experience in HRAM) then individually analyzed the manometry data (inter-observer variability). Intra-observer agreement was excellent (kappa 0.862) for classifying DD. Agreement between the six observations (i.e. two from observer 1 and four from independent observers) was also good (kappa 0.632). The highest agreement was for type 4 DD (kappa 0.738), followed by type 1 (0.680), type 2 (0.664), and type 3 (0.537). Cronbach's alpha value was 0.93, suggesting excellent internal consistency. The diagnosis of the types of DD on anorectal manometry using a water-perfusion system has excellent intra-observer and good inter-observer agreement.

Prospective analysis of surgical and functional outcomes after total proctocolectomy with ileal pouch-anal anastomosis in 86 patients with ulcerative colitis

Proctocolectomy with an ileal pouch‑anal anastomosis is currently considered the procedure of choice for the majority of patients with ulcerative colitis. Certain controversies about pouch design and pouch‑anal anastomosis technique remain a matter of debate, and possible advantages of laparoscopic approach are still being discussed.&#x0D; Objective — to investigate short‑term and long‑term outcomes of laparoscopic and open restorative proctocolectomy for UC in terms of postoperative morbidity and pouch function depending on the three types of construction of a neorectum described in our research.&#x0D; Materials and methods. 86 patients with inflammatory bowel disease underwent one‑stage or two‑stage restorative proctocolectomy. The two ileal pouch configurations were used: S‑pouch — in 16 patients and J‑pouch — in 70 patients. Removal of the distal rectum and ileal pouch‑anal anastomosis were performed using transanal distal rectum mucosectomy followed by a handsewn pouch‑anal anastomosis (n = 45) or a double‑stapled technique (n = 31). Laparoscopic approach was applied in 39 patients, and open surgery — in 47 patients. The short‑term (30 days after surgery) and long‑term surgical outcomes were prospectively studied. The analysis of functional outcomes was based on the number of bowel movements a day, episodes of fecal incontinence, seepage, and urgency. Instrumental investigation included measurement of the anal sphincter pressures and ileal pouch threshold volume as well as the study of its residual volume. Statistical analysis was performed using SPSS statistical software.&#x0D; Results. There was no postoperative mortality. In the laparoscopic group, 4 (10.3 %) patients had early postoperative complications compared with 13 (27.7 %) patients in the open surgery group, but the difference was not statistically significant (Fisher exact test value is 0.0579 at p &lt; 0.05). Pouch failure occurred in 4 patients. The second‑stage laparoscopic restorative procedure revealed the abdominal cavity almost free of adhesions in 19 (86.4 %) patients after laparoscopic total colectomy. The total number of early and late mucosectomy complications was significantly higher, 12 (75.0 %) vs. 10 (26.0 %) (p = 0.0018), in patients managed with a handsewn S pouch‑anal anastomosis than in patients treated with a J‑pouch‑anal anastomosis. Good functional outcomes were observed in 44 (51.0 %) patients. A strong negative correlation was found between the pouch threshold volume and the number of bowel movements per 24 hours (r = –0.7347, p &lt; 0.0001). The seepage episodes were detected in 30 (34.8 %) patients. The resting anal sphincter pressure was the only measured parameter which correlated accurately with the number of day and night seepage episodes (r = –074, p &lt; 0.0001).&#x0D; Conclusions. Good functional outcomes of construction of a neorectum were associated with the resting anal sphincter pressure (≥ 30 mm Hg) and ileal pouch threshold volume (150 — 250 ml). The S‑shaped and J‑shaped pouches demonstrated the same functional outcomes and posed similar risks. The S‑pouch was associated with a higher postoperative morbidity (p = 0.0018). There was no significant difference between laparoscopic and open surgery groups in terms of morbidity rate and functional outcomes. However, it was much easier to perform the second‑stage surgery after laparoscopy due to less adhesion formation.

Gastrointestinal motility disorders in patients with multiple sclerosis: A single-center study.

Most prevalent gastrointestinal symptoms in multiple sclerosis (MS) relate to lower bowel dysfunction, often in association with bladder manifestations. To assess clinical and objective gastrointestinal motor dysfunctions in patients with MS. This was a single-center, retrospective study of 166 patients evaluated between 1996 and 2020. We reviewed characterization of the MS, gastrointestinal and neurological symptoms, measurements of gastrointestinal and colonic transit, and anorectal manometry. At the time of the gastrointestinal evaluations of the 166 patients with MS (138 women; 83%), 111 were in the relapsing-remitting phase and 52 were in the progressive phase. In 3 patients, disease phase was not assigned due to insufficient data. Constipation was identified in 82% (136/166) of patients. Most [103/116 (88%)] patients with bladder symptoms also had constipation or fecal incontinence. Delayed gastric emptying at 4h and colonic transit at 24h was identified in 16% and 7% of the cohort, respectively; 22% had accelerated gastric emptying. On anorectal manometry, resting anal sphincter pressure >90mmHg and rectoanal pressure differential below -50mmHg suggested evacuation disorder in patients with constipation. In addition to slow colonic transit and anorectal dysfunction leading to constipation in MS, 22% of patients had accelerated gastric emptying.

Anal endosonographic assessment of the accuracy of clinical diagnosis of obstetric anal sphincter injury

Introduction and hypothesisObstetric anal sphincter injuries (OASIS) are a common cause of maternal morbidity with an overall incidence in the UK of 2.9% (range 0–8%). They can cause a range of physical symptoms and psychological distress. This study aims to assess the accuracy of clinical diagnosis of OASIS using endoanal ultrasound (EAUS) and the correlation between confirmed injury and change to anorectal physiology squeeze pressure and the incidence of bowel symptoms.Methods and materialsRetrospective study of prospectively collected data from 1135 women who attended the Third- and Fourth-Degree Tears Clinic at our institution, 12 weeks post-delivery, between June 2008 and October 2019.ResultsOASIS was confirmed in 876 (78.8%) women and 236 (21.3%) had no injury. Of the women who underwent anorectal physiology, 45.6% had a mean maximal resting pressure below the normal range and 68.8% had a mean incremental squeeze pressure below normal. Women with confirmed OASIS had significantly lower pressures (p < 0.001) than those without a confirmed sphincter injury. Three hundred ninety-three (34.8%) women reported bowel symptoms, with those with endosonographic evidence of injury more likely to develop flatus incontinence.ConclusionOf the women in this study with a suspected OASIS, 21.2% could be reassured that they did not have an injury. This information is useful for women considering future mode of delivery. Those with confirmed injury are more likely to complain of flatus incontinence and have reduced anal sphincter pressures.