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Multiple sclerosis is a chronic demyelinating neurological disease and causing a variety of neurological symptoms, including discomfort of anorectal Anal rectal disfunction.

Constipation and faecal incontinence present as anorectal dysfunction in MS and anal manometry, colonic transit time, electromyography, and defecography can be used for assessment.

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We presented a thirty-three years old Anal rectal disfunction with rare condition of anorectal dysfunction in multiple sclerosis. Anal manometry, defecography were done, and synchronously anal incontinence and mechanical constipation due to rectocele and anismus were detected in this patient.

Although anal incontinence and constipation are seen often in patients with multiple sclerosis, in the literature, coexistence of animus, rectocele and anal incontinence are quite rare. Defecography and anal manometry are useful diagnostic methods for demonstration of anorectal dysfuntions in patients with MS. Multiple sclerosis MS is a chronic neurological disease and characterised Anal rectal disfunction multiple demyelinating lesions within the central nervous system causing a variety of neurological symptoms, including discomfort of the urinary bladder and anorectal function.

Synchronously anal incontinence and mechanical constipation due to rectocele and Anal rectal disfunction were detected by the help of anal manometry and defecography in this patient. Thirty-three years old woman with history of 10 years multiple sclerosis was applied to general surgery with constipation, lower abdominal pain, and gas incontinence complains. There was no pathology at abdominal examination, laboratory tests, direct X-ray graphy. External impression was found at rectal examination.

She has a ten-year history of multiple sclerosis and her complains started at three years ago. Insufficient colonoscopy was done because of patient's inability of gas continence. Wexner anal incontinence score of the patient was 8. The patient underwent anal manometry. Resting pressure was normal but maximal squeeze pressure and endurance squeezing duration were significantly low that compatible with weak external anal sphincter muscle myogenic or neurogenic origin.

Defecography was done after necessary preparations. Additional to rectocele, there was no movement in puborectalis muscle PRM at the beginning, middle and end of straining puborectalis syndrome or anismus at defecography Fig.

J Am Coll Surg. Oct;(4)...

Defecographic images of the patient with multiple sclerosis. A View of rectum at filled with barium paste during rest.

1. Introduction

B View of rectum during Anal rectal disfunction showing pelvic floor elevation and impression of puborectal muscle which is normal. C Rectocele and lack of puborectalis muscle relaxation during straining.

D Increased size of rectocele and continued lack of puborectalis muscle relaxation during defecation. Initially biofeedback with medications for pain and constipation was recommended to patient. No benefit was seen from these actions two months after the first application in follow up.

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An advanced centre was recommended to the patient where a consensus can be reached among patient, neurologist and a gastrointestinal surgeon for treatment of this complicated disease. Anorectal dysfunction is very common in patients with MS and impact the quality of life.

The mechanism of ARD can be referred as normal or slightly decreased resting and a significantly decreased squeeze pressure in patients with constipation, and similar findings in faecal incontinence with an even higher incidence of impaired function of the external anal sphincter. Female sex, Anal rectal disfunction disability status scale and urinary dysfunctions are independent predictors for ARD in MS.

Anal rectal disfunction physiological studies demonstrate that in patients with MS who had anorectal dysfunction, there is a marked impairment of external anal sphincter function with moderate changes in pelvic floor musculature.

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The only anatomical defect was the presence of a rectocele in two patients. In Gill et al. Anorectal dysfunction is an important discomfort to patients with multiple sclerosis.

Although anal incontinence and constipation are seen often in patients with multiple sclerosis, when we look at the literature, coexistence of animus, rectocele and anal incontinence are quite rare. Additionally defecography and anal manometry are Anal rectal disfunction diagnostic methods for demonstration of anorectal dysfuntions in patients with MS.

The patient had anorectal complains accompanied by severe pain for a long time.

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Thus, she was very enthusiastic about the determination of diagnosis and treatment. The authors declare that they have no conflict of interest. All authors contributed equally to this study. No specific funding was received for this study Anal rectal disfunction we certify that there is no conflict of interest with any financial organization.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.


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