Anorectal Manometry Abnormalities in Ulcerative Colitis Patients: Anorectal Function Characterization and Its Clinical Relevance

Background: Ulcerative colitis (UC) is a chronic gastrointestinal condition characterized by persistent inflammation in the colonic mucosa and submucosa. Active mucosal inflammation has been suggested to induce hypersensitivity and visceral hyperactivity, resulting in chronic alterations in the rectal wall, such as fibrosis and reduced compliance. These changes may contribute to anorectal functional issues like incontinence, fecal urgency, and tenesmus, significantly impacting patients’ quality of life. This study aims to evaluate anorectal function abnormalities in UC patients and investigate their correlation with disease activity. Methods: In this cross-sectional study of 15 UC patients, we gathered comprehensive demographic, clinical, biochemical, endoscopic, and histological data. We assessed UC activity using the Truelove and Witts Scale (TWS), Mayo Endoscopic Subscore (MES), Riley Histological Index (RHI), and Yamamoto-Furusho Integral Index (FYII). Anorectal manometry was conducted using ManoScan 3D equipment. We employed SPSS version 26 to analyze correlations or associations between disease activity and anorectal manometry parameters. Statistical significance was determined at a p-value < 0.05. Results: Among UC patients, manometric findings revealed hypertonia in 46.7% at the internal anal sphincter (IAS) and 60% at the external anal sphincter (EAS). Furthermore, 20% exhibited abnormal defecation maneuvers, while 60% displayed alterations in rectal sensitivity. Defecatory dyssynergia was observed in two patients (13.3%) with type I and one patient (6.7%) with type II. Statistically significant associations emerged between disease extent and rectal sensitivity parameters, specifically first sensation (P< 0.01), urge to defecate (P< 0.02), and fecal urgency (P< 0.03). A negative correlation was noted between sensitivity parameters and disease extent, including first sensation (r=-0.57, P< 0.02), urge to defecate (r=-0.59, P< 0.02), and fecal urgency (r=-0.67, P< 0.001). Statistically significant differences were also detected between clinical and biochemical activity measured by TWS and the urge to defecate (P< 0.01), with a negative correlation between these parameters (r=-0.64, P< 0.01). Furthermore, disparities were observed in the degree of clinical activity measured by TWS (p=0.01) and the comprehensive YFII assessment (p=0.02), with negative correlations observed for both: TWS (r=-0.74, P< 0.001) and YFII (r=-0.61, P< 0.01). Conclusions: Anorectal function abnormalities, such as sphincter hypertonia, altered rectal sensitivity, and defecatory dyssynergia, were notable in UC patients. This study underscored the relevance of evaluating anorectal function in UC patients, as it revealed correlations between disease extent and severity and rectal sensitivity changes. This emphasis on anorectal assessment can contribute to improving the quality of life and treatment outcomes for these individuals.