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Paradoxical sphincter reaction and associated colorectal disorders

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Abstract

Of 71 patients with paradoxical sphincter reaction, 54 had symptoms of constipation or outlet obstruction and 17 were incontinent. The patients were investigated with defecography, colon transit time, anorectal manometry and electromyography. Ninety-six percent of the patients had additional changes in anorectal anatomy and physiology; 70% of the patients had abnormal defecography and 42% had delayed colon transit time. Decreased maximal anal pressure (MAP) and maximal squeeze pressure (MSP), indicating impaired function of the anal sphincters might be one reason for incontinence in patients with paradoxical sphincter reaction. The paradoxical reaction occurred in the puborectalis muscle and in three tested sites in the external sphincter. It is sufficient to record the EMG activity in one muscle and at one point to diagnose a paradoxical sphincter reaction. The absence of a normal closing reflex on electromyography is evidence for a paradoxical sphincter reaction. Denervation was more pronounced in the external sphincter than in the puborectalis muscle. The right pudendal nerve was subjected to damage more often than the left nerve.

Résumé

Parmi 71 patients présentant une réaction paradoxale du sphincter anal, 54 présentaient une constipation ou une dyschésie et 17 étaient incontinents. Ces patients avaient eu une défécographie, un temps de transit colique, une manométrie ano-rectale et une électromyographie. 96% d'entre eux présentaient des perturbations additionnelles de l'anatomie et de la physiologie ano-rectales. 70% de ces patients avaient une défécographie anormale et 42% un temps de transit colique prolongé. Une diminution de la pression anale maximale et de la pression de retenue maximale, indiquant une perturbation de la fonction des sphincters anaux, pourraient être une raison de l'incontinence de ces patients avec réaction paradoxale du sphincter. Cette réaction paradoxale survenait dans le muscle pubo-rectal et dans trois sites examinés du sphincter externe. Il est donc suffisant d'enregistrer l'électromyogramme dans un seul muscle et en un seul point pour diagnostiquer une réaction paradoxale du sphincter. L'absence d'un réflexe normal de fermeture en électromyographie témoigne d'une réaction paradoxale du sphincter. La dénervation était plus prononcée au niveau du sphincter externe que dans le muscle pubo-rectal. Le nerf honteux interne droit était plus souvent atteint que le nerf gauche.

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Authors and Affiliations

  1. Department of Surgery, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden

    C. Johansson, A. Mellgren, A. Dolk & B. Holmström

  2. Department of Clinical Neurophysiology, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden

    B. Y. Nilsson

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  1. C. Johansson
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  2. B. Y. Nilsson
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  3. A. Mellgren
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  4. A. Dolk
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  5. B. Holmström
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Johansson, C., Nilsson, B.Y., Mellgren, A. et al. Paradoxical sphincter reaction and associated colorectal disorders. Int J Colorect Dis 7, 89–94 (1992). https://doi.org/10.1007/BF00341293

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  • DOI: https://doi.org/10.1007/BF00341293

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