Abstract
PURPOSE: Several methods of neurophysiologic assessment exist in the investigation of patients with fecal incontinence. However, the clinical significance of the information gained is uncertain. The aim of this prospective study was to evaluate the results of pudendal nerve terminal motor latency and fiber density in relation to clinical variables and manometric measurements. METHODS: Seventy-two patients with fecal incontinence (63 women; mean age, 62; range, 24–81 years) responded to a bowel questionnaire and underwent anorectal manovolumetry, anal ultrasonography, defecography, and electromyography, including pudendal nerve terminal motor latency and fiber density. RESULTS: Pudendal neuropathy (pudendal nerve terminal motor latency >2.5 ms) was found in 46 percent and increased fiber density (>1.7) in 82 percent. Pudendal neuropathy and increased fiber density were most common in patients with rectal prolapse or intra-anal intussusception. No difference was seen concerning anal resting and incremental pressures, rectal compliance, rectal sensibility or severity of incontinence in patients with unilateral, bilateral, or marked (>4 ms) pudendal neuropathyvs. patients with normal pudendal nerve terminal motor latency. In contrast, patients with increased fiber density had lower incremental pressures (P<0.05) and stated decreased rectal sensibility (P<0.05) compared with those with normal fiber density. These differences were most pronounced in patients with neurogenic or idiopathic incontinence. CONCLUSIONS: Pudendal neuropathy and increased fiber density are common in patients with fecal incontinence. Fiber density but not pudendal nerve terminal motor latency was correlated with clinical and manometric variables. The severity of nerve injury correlated with anal motor and sensory function in patients with neurogenic or idiopathic incontinence. The routine use of pudendal nerve terminal motor latency in the assessment of patients with fecal incontinence can be questioned.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wexner SD, Marchetti F, Salanga VD, Corredor C, Jagelman DG. Neurophysiologic assessment of the anal sphincters. Dis Colon Rectum 1991;34:606–12.
Cheong DM, Vaccaro CA, Salanga VD, Wexner SD, Phillips RC, Hanson MR. Electrodiagnostic evaluation of fecal incontinence. Muscle Nerve 1995;18:609–12.
Österberg A, Graf W, Karlbom U, Påhlman L. Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation. Scand J Gastroenterol 1996;31:575–80.
Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.
Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989;32:737–42.
Neill ME, Swash M. Increased motor unit fibre density in the external anal sphincter muscle in ano-rectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 1980;43:343–7.
Dhaenens G, Emblem R, Ganes T. Fibre density in idiopathic ano-rectal incontinence. Electromyogr Clin Neurophysiol 1995;35:285–90.
Holmberg A, Graf W, Österberg A, Påhlman L. Anorectal manovolumetry in the diagnosis of fecal incontinence. Dis Colon Rectum 1995;38:502–8.
Åkervall S, Fasth S, Nordgren S, Öresland T, Hultén L. Manovolumetry: a new method for investigation of anorectal function. Gut 1988;29:614–23.
Karlbom U, Påhlman L, Nilsson S, Graf W. Relationships between defecographic findings, rectal emptying and colon transit time in constipated patients. Gut 1995;36:907–12.
Miller R, Bartolo DC, Locke-Edmunds JC, Mortensen NJ. Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 1988;75:101–5.
Jones PN, Lubowski DZ, Swash M, Henry MM. Relation between perineal descent and pudendal nerve damage in idiopathic faecal incontinence. Int J Colorectal Dis 1987;2:93–5.
Laurberg S, Swash M, Henry MM. Delayed external sphincter repair for obstetrical tear. Br J Surg 1988;75:786–8.
Jacobs PP, Scheuer M, Kuijpers JH, Vingerhoets MH. Obstetric fecal incontinence: role of pelvic denervation and results of delayed sphincter repair. Dis Colon Rectum 1990;33:494–7.
Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 1991;34:22–30.
Lubowski DZ, Jones PN, Swash M, Henry MM. Asymmetrical pudendal nerve damage in pelvic floor disorders. Int J Colorectal Dis 1988;3:158–60.
Wunderlich M, Swash M. The overlapping innervation of the two sides of the external anal sphincter by the pudendal nerves. J Neurol Sci 1983;59:97–109.
Tetzschner T, Sorensen M, Rasmussen OO, Lose G, Christiansen J. Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth. Acta Obstet Gynecol Scand 1995;74:434–40.
Vernava AM III, Longo WE, Daniel GL. Pudendal neuropathy and the importance of EMG evaluation of fecal incontinence. Dis Colon Rectum 1993;36:23–7.
Fleshman JW, Dreznik Z, Cohen E, Fry RD, Kodner IJ. Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum 1992;35:1019–25.
Ståhlberg E, Trontelj J. Single fibre electromyography. London: Mirvalle Press, 1979.
Parks AG, Swash M. Denervation of the anal sphincter causing idiopathic ano-rectal incontinence. J R Coll Surg Edinb 1979;24:94–6.
Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.
Snooks SJ, Setchell M, Swash M, Henry MM. Injury to the innervation of the pelvic floor sphincter musculature in childbirth. Lancet 1984;546–50.
Sangwan YP, Coller JA, Barrett RC,et al. Unilateral pudendal neuropathy: impact on outcome of anal sphincter repair. Dis Colon Rectum 1996;39:686–9.
Author information
Authors and Affiliations
Additional information
Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.
About this article
Cite this article
Österberg, A., Graf, W., Eeg-Olofsson, K.E. et al. Results of neurophysiologic evaluation in fecal incontinence. Dis Colon Rectum 43, 1256–1261 (2000). https://doi.org/10.1007/BF02237432
Issue Date:
DOI: https://doi.org/10.1007/BF02237432