Long-standing diabetes mellitus (DM) is associated with progressive autonomic neuropathy, which may significantly impair gastrointestinal function, including rectal sensory pathways. Altered rectal perception has been linked to functional disorders such as constipation and fecal incontinence. However, its characterization using high-resolution anorectal manometry (HRAM) in patients with chronic DM remains insufficiently defined.

To evaluate rectal sensory alterations in patients with diabetes mellitus of ≥10 years duration and to analyze their association with disease duration.

A retrospective, observational, and analytical study was conducted, including patients with DM ≥10 years who underwent HRAM. Rectal sensory thresholds were assessed using balloon distension, recording volumes for first sensation, desire to defecate, and urgency.

Exclusion criteria included patients without DM, disease duration <10 years, incomplete studies, prior anorectal surgery, and neurological disorders.

Statistical analysis included mean ± standard deviation, percentage distribution, and Pearson correlation (p<0.05).

A total of 49 patients were included. Mean values were 70.3 ± 39.2 ml for first sensation, 118.6 ± 45.4 ml for desire, and 154.0 ± 41.6 ml for urgency, showing a shift toward higher sensory thresholds.

Hyposensitivity predominated, with fewer normal cases and minimal hypersensitivity.

A positive correlation was observed between DM duration and first sensation (r≈0.30).

These findings are consistent with diabetic autonomic neuropathy affecting rectal afferent pathways. Reduced perception may lead to delayed defecation and increased risk of fecal retention or incontinence.

HRAM allows objective assessment and may guide management strategies.

Limitations include retrospective design and lack of control group.

Patients with long-standing DM exhibit a clear pattern of rectal hyposensitivity that correlates with disease duration, supporting the presence of progressive autonomic neuropathy affecting anorectal sensory function. These alterations may contribute to delayed rectal perception, impaired defecatory reflexes, and an increased risk of both constipation and fecal incontinence.
HRAM provides an objective and reproducible method for early identification of these dysfunctions, allowing for better phenotyping of patients and more targeted therapeutic strategies. Importantly, these findings highlight a potential window for early intervention, where therapies such as electrostimulation and pelvic floor rehabilitation may help modulate sensory dysfunction before the development of advanced or irreversible damage.
This study underscores the importance of incorporating anorectal functional assessment into the evaluation of patients with chronic DM and supports a proactive, multidisciplinary approach aimed at preventing progression to more complex pelvic floor disorders. Further prospective and controlled studies are warranted to confirm these findings and to define optimal timing and modalities of intervention.

Continence 19S (2026) 102727
DOI: 10.1016/j.cont.2026.102727