Pelvic Floor Dyssenergia: It’s Relevance to the Anorectal Bowel Dysfunctions and Management Guidelines

Neural control of the pelvic organs is one of the most intriguing in the body involving both autonomic and somatic components organized in the thoraco-lumbar (sympathetic), lumbosacral (somatic), and sacral (parasympathetic) spinal cord. Loss of supraspinal descending control and plasticity-mediated alterations at the level of the spinal cord, result in loss of voluntary control and in abnormal functioning of these systems including the development of dyssynergia and spasticity. Originally DSD has been used for Bladder external urethral sphincter discoordination, also known as detrusor external sphincter dyssynergia. The ICS standard terminology agreed in 1998, “ DSD is a consequence of a neurological pathology such as spinal cord injury or multiple sclerosis that disrupts central nervous system regulation of the Micturition (urination) reflex, resulting in discoordination of the detrusor muscles of the bladder and the external urethral sphincter muscles [1]”. Since anal external sphincter and external urethra sphincter share essentially the same innervations [2], these patients also have Ano-rectal and Pelvic floor dyssenergia (PVD) following spinal cord lesions. The terms Detrusor Sphincter Dyssenergia (DSD) and dyssenergic response indicated uncoordinated external urethral sphincter (EUS) on attempted voiding in complete and incomplete spinal cord injury lesions [1]. In normal persons attempted voiding leads to the relaxation of the external urethral sphincter; however in any supraconal spinal cord lesion below Pontine Micturition Center, there is a failure of relaxation of the urethral sphincter which leads to retention of urine. In incomplete lesions there may be some intermittent relaxation on attempted voiding which was referred as dyssenergic response [3]. This can be demonstrated on simultaneous recording of bladder pressures [Manometry] and a periurethral EMG studies.