Purpose: The aim of this study was to investigate any possible relation between the severity of anorectal dysfunction in diabetes mellitus and duration of disease and presence of microangiopathy or neuropathy or both.
Methods: Standard multiport anorectal manometry was performed in 25 healthy control subjects (10 males; age (mean +/- 1 standard deviation), 62 +/- 14 years) and 38 patients with diabetes mellitus. Patients were divided into two groups according to the duration of the disease: Group A (19 patients) with a duration less than 10 years (7.2 +/- 2.5; 8 males; age, 57 +/- 18) and Group B (19 patients) with a duration longer than 10 years (19.8 +/- 5.6; 6 males; age, 62 +/- 15).
Results: Results are reported as mean +/- one standard deviation. Patients showed lower resting and squeeze anal pressures (P < 0.01), impaired rectoanal inhibitory and anocutaneous reflexes, and reduced sensitivity in rectal distention (P = 0.004) as compared with controls. In addition, Group B showed a significantly increased incidence of microangiopathy (P = 0.04) and autonomic and peripheral neuropathy (P = 0.002), significantly reduced basal and squeeze anal pressures (52 +/- 16 vs. 64 +/- 24 mmHg; P = 0.03 and 98 +/- 39 vs. 124 +/- 54 mmHg; P = 0.04, respectively), reduced amplitude of slow waves (7.3 +/- 3 ts. 9.5 +/- 3.7 mmHg; P = 0.03), anal leak in smaller rectal volumes (P = 0.003), and reduced response of the anal sphincter at the anocutaneous reflexes (29 +/- 14 vs. 39 +/- 14 mmHg; P = 0.05) compared with Group A. The former group of patients exhibited a significantly higher incidence of fecal incontinence (P = 0.008).
Conclusion: Patients with long-standing diabetes mellitus have increased incidence of fecal incontinence and severely impaired function of both the anal sphincters and the rectum. These findings could be attributed to the increased incidence of microangiopathy and autonomic and peripheral neuropathy observed in this subset of diabetic patients.