(spinal cord injury or surgery, multiple sclerosis, stroke, closed head injury, Freidrich’s ataxia, Parkinsons’s, myelodysplasia, radiculopathy, spinal stenosis, focal cortical brain lesion, epilepsy, or cerebral palsy) and in 18% of those without neurological disease (p=0.05, N = 373). Conversely, 64% of those with rectal contractions had neurological disease or risk factors (e.g. spinal surgery), versus 52% with no rectal contraction. Rectal contractions were associated with early sensation (p = 0.02) and presence of detrusor external sphincter dyssynergia (DESD, p=0.05). There was no correlation with urgency or urge incontinence, gastrointestinal disorders, detrusor overactivity, or bladder compliance. Adding repeat testing to the analysis, the percent of studies positive for rectal contractions correlated with the presence of neurologic disease (p = 0.02) and presence of DESD (p = 0.005). CONCLUSIONS: A higher proportion of those who demonstrate rectal contractions on urodynamic testing have neurologic disease. Rectal contractions raise the index of suspicion for neurogenic voiding dysfunction.