Anorectal physiology and colonic motility in children with a history of tethered cord syndrome

ObjectivesThe understanding of the impact of tethered cord syndrome (TCS) on the physiology of the colorectal area is limited. Our aim was to describe anorectal and colonic motility in children with TCS and compare the findings to those of children with functional constipation (FC).MethodsWe conducted a retrospective review of children with TCS who had an anorectal manometry (ARM) performed at our institution from January 2011 to September 2023. We recorded demographics, medical and surgical history, clinical symptoms, and treatment at time of ARM, ARM findings (resting pressure, push maneuver, rectal sensation, rectoanal inhibitory reflex [RAIR], and RAIR duration), and the final interpretation of colonic manometry (CM) if performed. We identified age and sex-matched control groups of children with FC.ResultsWe included 24 children with TCS (50% female) who had ARM testing (median age at ARM 6.0 years, interquartile range 4.0-11.8 years). All children had constipation at time of ARM. Nineteen children had detethering surgery before ARM was performed. No significant differences in ARM parameters were found between children who had detethering surgery before ARM and children with FC. Among the 24 children, 14 also had a CM performed (13/14 after detethering surgery). No significant differences in colonic motility were found between children with a history of TCS and children with FC.ConclusionsAnorectal physiology and colonic motility are similar between children with a history of TCS and children with FC, suggesting that the underlying pathophysiology of defecatory disorders in children with and without history of TCS is similar. What is Known The understanding of the impact of tethered cord syndrome (TCS) on the physiology of the colorectal area is limited. Even after detethering surgery, fecal incontinence and constipation are commonly seen in children with TCS.What is New No significant differences in anorectal manometry findings and colonic motility were found between children with a history of TCS and an age and sex-matched cohort of children with functional constipation. The underlying pathophysiology of defecatory disorders in children with and without a history of TCS might be similar and not related to differences in colonic motor function.