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Alterations of rectal sensation and anal sphincter muscles occur frequently in multiple sclerosis patients. Cord lesions, there is poor sensation of rectal filling, poor rectal tone, and loss of voluntary contraction of the external anal sphincter. Fecal incontinence (fi), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas) it is referred to as anal incontinence. Incontinence can result from different causes and might occur with either constipation. Some authors have reported a mean normal anal resting pressure ranging from 57 10 mm hg 106 to 67 12 mm hg, 113 maximum squeeze pressure ranging from 118 42 mm hg 106 to 140 52 mm hg, 113 anal length around 3. 8 cm, 113 threshold to produce relaxation (rair) ranging from 5 1 ml 106 to 11 5 ml, 113 the threshold of rectal sensation ranging from 5 2 ml 106 to 14 7. Though resting sphincter tone is predominantly attributed to the internal anal sphincter, studies under general anesthesia or after pudendal nerve block suggest the external anal sphincter generally accounts for approximately 25, and up to 50, of resting anal tone. anal sphincter tone is patulous and should always be tested since it can define the completeness of the injury (with bulbocavernosus reflex) it is also useful in monitoring recovery from the injury. Urinary incontinence could also occur secondary to loss of urinary sphincter tone this may also present initially as urinary retention secondary to a flaccid bladder. Patients with lesions above the cone usually suffer from an overactive bowel with increased colonic wall and anal tone. in the sacral segmental examination, he had a weak voluntary anal contraction and absent anal reflex, despite normal anal sensation and tone, and the presence of the bulbocavernosus reflex. Anal manometry also reveals absent sensation and lack of ano-rectal tone. In conus medullaris lesions, findings of denervation in the pelvic floor muscles and sphincters are expected but are often not seen in the lower extremities as weakness in these muscles are typically caused by upper motor neuron injury. Cauda equina syndrome (ces) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. The cause is usually a disc herniation in the lower region of the back.