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Pudendal nerve terminal motor latency testing does not provide useful information in guiding therapy for fecal incontinence

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Pudendal nerve terminal motor latency (PNTML) testing is a standard recommendation for the evaluation of fecal incontinence. Its role in guiding therapy for fecal incontinence has been previously questioned. The aim of this study was to evaluate the relationship between PNTML testing and anorectal dysfunction.

Methods

This was a retrospective analysis of data collected prospectively from patients who presented to a pelvic floor disorder center from 2007 to 2015. The relationship between PNTML (normal versus delayed) and anorectal manometry, fecal incontinence severity, and fecal incontinence-related quality of life scores was assessed using the Wilcoxon-Mann-Whitney test.

Results

Two hundred sixty-nine patients underwent PNTML testing, and 91.1% were female (N = 245) (median age 62.2 years). Normal PNTML was seen in 234 (87.0%) patients. Among 268 patients who underwent anorectal manometry, delayed PNTML was only significantly associated with median maximum anal squeeze pressure (P = 0.04). Delayed PNTML was not associated with a decrease in median fecal incontinence severity or fecal incontinence-related quality of life scores (N = 99).

Conclusions

PNTML was only associated with median maximum anal squeeze pressure, and it was not associated with patient-reported severity of symptoms of fecal incontinence, changes in quality of life attributable to fecal incontinence, median mean resting anal pressure, or median maximum resting anal pressure. PNTML testing may not be relevant to current therapeutic algorithms for fecal incontinence and its routine use should be questioned.

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Author notes

  1. Julia T. Saraidaridis and George Molina contributed equally to this work.

Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA, USA

    Julia T. Saraidaridis

  2. Colorectal Surgery Program and the Center for Pelvic Floor Disorders, Massachusetts General Hospital, Boston, MA, USA

    Julia T. Saraidaridis, George Molina, Lieba R. Savit, Holly Milch, Tiffany Mei, Samantha Chin, James Kuo & Liliana Bordeianou

  3. Harvard Medical School, Boston, MA, USA

    George Molina, Lieba R. Savit & Holly Milch

  4. Brandeis University, Waltham, MA, USA

    Tiffany Mei, Samantha Chin, James Kuo & Liliana Bordeianou

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  1. Julia T. Saraidaridis
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  2. George Molina
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Ethics declarations

This study was approved by the Partners Healthcare Institutional Review Board.

Conflict of interest

The authors declare that they have no conflict of interest.

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Saraidaridis, J.T., Molina, G., Savit, L.R. et al. Pudendal nerve terminal motor latency testing does not provide useful information in guiding therapy for fecal incontinence. Int J Colorectal Dis 33, 305–310 (2018). https://doi.org/10.1007/s00384-017-2959-5

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  • DOI: https://doi.org/10.1007/s00384-017-2959-5

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