A winking anus may signify spinal injury.
نویسندگان
چکیده
Case report—A 41 year old woman was referred for assessment of worsening bladder and bowel dysfunction. At the age of 17 years she had suVered a traumatic fracturesubluxation of T12–L1 following a trampoline accident in which she fell heavily on to her back. She immediately lost sensation below the waist but this returned over several days. Following eight weeks of bed rest she gradually regained the ability to walk. She subsequently had no neurological deficit in her legs. Since the accident she had experienced bladder and bowel dysfunction. She experienced urinary frequency, urgency, urge incontinence, and episodes of spontaneous bladder emptying without warning. There had been no stress incontinence. Urodynamic studies showed a small capacity bladder of 257 ml but good voiding and minimal residual volume (30 ml). She did however have marked urgency at 150 ml. From a gastrointestinal point of view, she developed constipation following her injury. During her twenties she passed several small firm stools daily. During her thirties she developed episodes of abdominal pain, occurring approximately every two months, followed by diarrhoeal episodes over several hours. Continence was not impaired. Colonoscopy was normal. On rectal examination the anus was closed at rest and of reasonable tone initially but gaped after digital examination (figs 1, 2) for several minutes, with eventual return to normal resting tone. Palpable voluntary anal sphincter contraction was absent. Perianal skin sensation to light touch and pinprick was reduced. Anorectal physiological testing showed a low maximum resting anal pressure (45 cm H2O, normal >60), indicating internal anal sphincter dysfunction, and a low maximum anal squeeze pressure (8 cm H2O, normal >60), indicating external sphincter dysfunction. The sensory threshold to an electrical stimulus was grossly abnormal in both the rectum (61 mA, normal <35) and the anal canal (88 mA, normal <12). Management consisted of simple symptomatic measures, including analgesics and antidiarrhoeal medications as required. Discussion—Bowel dysfunction is common in the general population but is especially common after spinal injury. A study of 115 chronically spinally injured patients showed that 95% experienced constipation, faecal incontinence, or both. Fifty per cent of patients relied on the help of another person for bowel evacuation. Patients rated their bowel disability almost as troublesome as their loss of physical mobility, and worse than their urinary symptoms. Although these data refer to patients with permanent paraor quadriplegia, bowel dysfunction can also persist after partial or transient spinal lesions. As bowel dysfunction is also common in the general population, especially in young women, it is helpful to have a test that distinguishes idiopathic functional disturbance from that related to permanently impaired neurological innervation. This is important for clinical reasons, as the former may respond more easily to behavioural techniques such as biofeedback retraining. It is also of medicolegal importance. The testing of rectal sensation to an electrical stimulus often enables this distinction to be made, providing clear evidence in our patient of impaired innervation. To our knowledge the sign of anal gaping after digital examination as a marker of neurological impairment has not been described previously. Normally the anal canal remains closed before, during, and after examination. The decrease in anal tone after digital examination in this patient may reflect loss of the normal extrinsic parasympathetic excitatory drive to the internal anal sphincter smooth muscle which maintains tone, and unopposed extrinsic sympathetic drive which relaxes the sphincter. Given that this was a T12–L1 lesion, only part of the sympathetic outflow may have been lost. It is uncertain what proportion of parasympathetic and sympathetic
منابع مشابه
The Role of Self-Esteem on Vocational Rehabilitation of People with Spinal Cord Injury
Rehabilitation is the ongoing management of injuries and disabilities after an accident. It will help people to maximize the individuals` recovery through the relearning of skills or teaching of strategies to compensate for changed abilities. Self-esteem may be one major factor related to the manner in which people with Spinal Cord Injury (SCI) respond to rehabilitation. Following a short discu...
متن کاملA Review of the Occurrence and Mechanisms of Induction of Osteoporosis Following Spinal Cord Injury
Introduction: Spinal cord injury (SCI) causes devastating injuries in patients. The main mechanisms of the pathogenesis of secondary injury include nerve degeneration, gliosis, and inflammation. Spinal cord injury induces a disorder or failure in several organs due to the vital role of the spinal cord in regulating bodily functions. Osteoporosis is a consequence of spinal cord injury that occur...
متن کاملCellular and Molecular Mechanisms Involved in Neuroinflammation after Acute Traumatic Spinal Cord Injury
Introduction: Spinal cord injury (SCI) following traumatic events is associated with the limited therapeutic options and sever complications, which can be partly due to inflammatory response. Therefore, this study aims to explore the role of inflammation in spinal cord injury. The findings showed that the pathological conditions of nervous system lead to activation of microglia, astrocyte, neut...
متن کاملP145: Vitamins Level Change in Spinal Cord Injury
Spinal cord injury (SCI) is damage to the spinal cord that leads to sudden loss of motor and autonomic function and sensory under the level of the injury. Studies showed that individuals with SCI has a clear tendency to vitamins level change. The aim of this study was to review the vitamins level in spinal cord injury. Vitamins C level decrease in the injured spinal cord patient. Vitamins C hav...
متن کاملProtective effect of aqueous spinach (Spinacia oleracea L.) extract on spinal cord ischemia-reperfusion injury in rats
Operation on the thoraco-abdominal aorta may lead to paraplegia or paraparesis is after spinal ischemia/reperfusion (I/R) injury. In this study, we investigated the protective effect of the spinach extract on spinal cord I/R injury. Thirty-five male Sprague-Dawley rats were divided into five groups: Intact, sham surgery, normal saline (NS), low dose spinach extract (20 mg kg-1), high...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Gut
دوره 48 5 شماره
صفحات -
تاریخ انتشار 2001