Le plancher pelvien neurologique et le gastro-entérologue
ABSTRACT Ce papier fait la revue des affections neurologiques associées à un dysfonctionnement du plancher pelvien et qui engendrent
une constipation, une défécation difficile ou une incontinence.
La maladie de Parkinson, l’atrophie multisystémique, les accidents vasculaires cérébraux, les traumatismes médullaires de
même que les atteintes de la queue de cheval, les neuropathies périphériques incluant le diabète, et les myopathies seront
L’intérêt de la manométrie anorectale, de la défécographie, de l’électromyographie périnéale sera rappelé. Des traitements
et des conseils seront donnés pour les différentes affections neurologiques.
This paper is reviewing various neurological disorders associated with pelvic floor dysfunctions such as constipation, difficult
defecation or incontinence.
Parkinson’s disease (PD) and multiple system atrophy (MSA), cerebrovascular accidents (CVA), spinal cord injury (SCI) as well
as peripheral neuropathy including diabetes will be discussed.
The main value of anorectal manometry, defecography or perineal electromyography will be highlighted. Treatment and advice
will be noted for each neurological diseases.
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ABSTRACT: A parkinsonian patient with severe outlet-type constipation was treated with injection of botulinum toxin into the puborectalis muscle. A total of 30 units (Botox) was injected in two sites. Resting anal pressure, maximum voluntary contraction, and pressure on straining were evaluated before treatment and 4, 8, 12, and 16 weeks afterward. Pressure values declined following treatment, the decline of pressure on straining ending by week 12. Proctography performed 8 weeks after treatment showed improvement in the anorectal angle and evacuation of barium paste. The clinical benefit lasted for approximately 12 weeks. The present data show that botulinum toxin is a promising tool for treating outlet-type constipation in Parkinson's disease.Movement Disorders 09/1997; 12(5):764-6. DOI:10.1002/mds.870120524 · 5.63 Impact Factor
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ABSTRACT: We evaluated the effects of the dopaminergic agent apomorphine on defecation and anorectal function in patients with Parkinson's disease (PD). A gastrointestinal symptom survey, extrapyramidal assessment, defecating proctogram, and anorectal manometric study were performed in 8 subjects with PD. Basal studies showing abnormalities were repeated following apomorphine administration. Prior defecographic abnormalities were normalized following apomorphine injection in 1 of 3 subjects and significant improvements in manometric parameters were observed in all 5 subjects who underwent repeat anorectal manometry. We conclude that apomorphine can correct anorectal dysfunction in PD, and that these abnormalities may be a consequence of dopamine deficiency secondary to the PD process. These findings may also have therapeutic implications.Annals of Neurology 05/1993; 33(5):490-3. DOI:10.1002/ana.410330512 · 11.91 Impact Factor
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ABSTRACT: Thirty patients with multiple sclerosis (MS) [18 men and 12 women, mean age 40 years (range 22-50), disease duration 12 years (range 0.5-34), Kurtzke's Expanded Disability Status Score 6.0 (range 4.0-7.5)] were interviewed about bowel symptoms and studied using ano-rectal manometry. The results were compared with findings in healthy controls. Twenty-eight had bowel symptoms: 8 constipation, 10 constipation and infrequent faecal urgency, 4 infrequent faecal incontinence and 6 frequent faecal incontinence. Anal sphincter pressure at rest was significantly reduced in MS patients 69 (SD 17) cm H2O, compared with 92 (SD 15) cm H2O in controls, and the external sphincter contraction force was also significantly reduced. Rectal sensation and rectal compliance were reduced and the ano-rectal inhibition reflex (defaecation reflex) required a higher rectal pressure to be elicited in the patients. Upon rectal filling, an early external sphincter excitation was seen. The presence of faecal incontinence correlated strongly with reduced rectal sensation. The findings suggest that faecal incontinence can at least partly be explained by low anal sphincter pressure and poor rectal sensation. The findings of early sphincter excitation and increased threshold of ano-rectal inhibition reflex may be an important pathophysiological factor for constipation in MS patients.Journal of Neurology 07/1996; 243(6):445-51. DOI:10.1007/BF00900497 · 3.84 Impact Factor