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Rectal compliance is increased in Spinal Cord Injury (SCI) patients with injury level above T5. Often this patient group has also associated bladder dysfunction, requiring anti-muscarinic agents. We assessed their physiological effect on the ano-rectal function of patients with SCI above T5.Weprospectively collected data from 11 patients with established SCI above T5, and eight had an ASIA complete injury. Anal manometry, assessment of rectoanal inhibitory reflex (RAIR) and rectal compliance were measured at baseline and after anti-muscarinic treatment was started. Bowel symptoms were quantified with Wexner scores for incontinence and constipation.Rectal compliance was significantly increased (19.7 ± 5.7 vs 24.2 ± 4.5 P = 0.0005). When analyzing the three components of the RAIR, the percent amplitude of maximal sphincter relaxation was decreased (pre versus post: 49 ± 9 vs 37 ± 7%, P = 0.0005) and excitation latency was increased (1.3 ± 0.7 vs 1.8 ± 0.7 seconds, P = 0.0005). Wexner score for constipation had significantly increased (15.5 ± 7.9 vs 18.9 ± 6.8 P = 0.0155).In SCI patients the use of anti-muscarinic agents causes increased rectal compliance, reduced reflex relaxation of the anal sphincter and delayed latency of this reflex. These changespredispose towards constipation. This underline the importance of tonic parasympathetic anorectal reflex functioning.