Abstract
In a prospective electromyographic and manometric study on 23 women (average age 52 years) with obstructive defecation disorder the activity of the external anal sphincter muscle and the puborectal muscle was investigated at rest and during contraction and straining. The control group consisted of 22 healthy women with an average age of 53 years. The main aim of the study was to investigate the functioning of the two muscles during simulated defecation (maximum strain) and to examine any changes in the pressure ratio in the rectum and the anal canal during this stimulation. There were no significant differences in the resting pressure, the contraction pressure and the straining pressure (in the rectum and the anal canal) between the two groups. The functioning of the puborectal muscle and the external anal sphincter muscle was largely the same in both the study group and the control group. No statistically significant differences were found between the two groups except in the amplitude of contraction. When we tried to list the change in the activity of the muscle as an index of anism, we were not able to objectify such a change for either the external anal sphincter muscle or the puborectal muscle. We therefore conclude that the increase in the activity of the voluntary muscle of the pelvic floor observed on electromyography during defecation does not indicate a pathologic condition but is a functional state.
Zusammenfassung
In einer prospektiven elektromyographischen und manometrischen Studie wurde die Aktivität des M. sphincter ani externus und M. puborectalis bei Ruhe, Kontraktion und Pressen bei 23 Frauen (Durchschnittsalter 52 Jahre) mit obstruktiven Defäkationsstörungen untersucht. Als Kontrollgruppe dienten 22 gesunde Frauen mit einem durchschnittlichen Alter von 53 Jahren. In erster Linie sollte überprüft werden, wie die beiden Muskeln sich bei einer simulierten Defäkation (maximales Pressen) funktionell verhalten, und wie die Druckverhältnisse sich im Rektum und Analkanal dabei ändern. Ruhe-, Kontraktions- und Preßdruck (Rektum und Analkanal) zeigten zwischen den beiden Gruppen keine signifikanten Unterschiede. Puborectalis und Externus zeigten weitgehend sowohl in der Patienten- als auch in der Kontrollgruppe ein identisches Verhalten. Bis auf die Kontraktionsamplitude des M. puborectalis konnte man keine weitere statistischen Unterschiede zwischen den beiden Gruppen nachweisen. Beim Versuch, die veränderte Aktivität als Anismusindex zu erfassen, konnte eine solche Veränderung weder für den M. sphincter ani externus noch für den M. puborectalis objektiviert werden. Daraus folgern wir, daß eine elektromyographisch nachgewiesene Aktivitätszunahme der willkürlichen Beckenbodenmuskulatur während der Defäkation weniger eine pathologische Situation, sondern vielmehr einen Funktionszustand repräsentiert.
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Athanasiadis, S., Kuprian, A. & Stüben, R. Elektromyographisches aktivitätsverhalten des M. sphincter ani externus und M. puborectalis im defäkationstest bei patienten mit obstruktiven Entleerungsstörungen. Langenbecks Arch Chir 379, 204–209 (1994). https://doi.org/10.1007/BF00186359
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DOI: https://doi.org/10.1007/BF00186359