Article

Constipation and fecal incontinence are considerable problems for
most individuals with spinal cord injury (SCI). Neurogenic bowel symptoms are
caused by several factors including abnormal rectal wall properties. Stimulation
of the dorsal genital nerve (DGN) can inhibit bladder contractions and because of
common innervation inhibitory effects are anticipated in the rectum too.
Therefore, DNG could have a future role in the treatment of neurogenic fecal
incontinence. AIM: To study the effect of acute DGN stimulation on the rectal
cross sectional area (CSA) in SCI patients. METHODS: Seven patients with complete
supraconal SCI (median age 50 years) were included. Stimulation was applied via
plaster-electrodes using an amplitude of twice the genito-anal reflex threshold
(pulse width: 200 mus; pulse rate: 20 Hz). A pressure controlled phasic (10, 20
and 30 cmH(2)O) rectal distension protocol was repeated four times with subjects
randomized to stimulation during 1st and 3rd distension series or 2nd and 4th
distension series. The rectal CSA and pressure were measured using impedance
planimetry and manometry. RESULTS: All patients completed the investigation.
Median stimulation amplitude was 51 mA (range 30-64). CSA was smaller during
stimulation and differences reached statistical significance at distension
pressures of 20 cmH(2)O (average decrease 9%; P = 0.02) and 30 cmH(2)O (average
decrease 4%; P = 0.03) above resting rectal pressure. Accordingly, rectal
pressure-CSA relation was significantly reduced during stimulation at 20 (P=0.03)
and 30 cmH(2)O distension (P=0.02). CONCLUSION: DGN Stimulation in patients with
supraconal SCI results in an acute decrease of rectal CSA and the rectal
pressure-CSA relation.

Langue : ANGLAIS