Skip to main content

Reflex Testing and Pelvic Examination

  • Chapter
  • First Online:
Suprapontine Lesions and Neurogenic Pelvic Dysfunctions

Abstract

In daily practice, the instrumental diagnosis is often emphasised, but in the patient with a suprapontine lesion the clinical examination is critical: assessing perineal sensory function, abdominal and cremasteric reflexes and reflexes of the sacral arch can allow, in addition to a more precise diagnosis, a more accurate and safe rehabilitation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Tarulli AW. Disorders of the cauda equina. Continuum (Minneap Minn). 2015;21:146–58.

    Google Scholar 

  2. Robert R, Labat JJ, Riant T, et al. Somatic perineal pain other than pudendal neuralgia. Neurochirurgie. 2009;55(4–5):470–4.

    Article  CAS  PubMed  Google Scholar 

  3. Bensignor-Le Henaff M, Labat JJ, Robert T, et al. Perineal pain and lesions of the internal pudendal nerves. Cah Anesthesiol. 1993;41(2):111–4.

    CAS  PubMed  Google Scholar 

  4. Bensignor-Le Henaff M, Labat JJ, Robert R, Lajat Y, et al. Perineal pain and involvement of the internal pudendal nerves. Agressologie. 1991;32:277–9.

    CAS  PubMed  Google Scholar 

  5. Bouchet A, Cuilleret J. Anatomie topographique descriptive et fonctionnelle, tome 3b, Le membre inferieur. 3e éd ed. Paris: Simep/Masson; 1995.

    Google Scholar 

  6. Kamina P. Précis d’anatomie clinique, tome I. 1re éd ed. Paris: Maloine; 2002.

    Google Scholar 

  7. Rouvière H, Delmas A, Delmas V. Anatomie humaine descriptive, topographique et fonctionnelle, tome 3, Membres. 15e éd ed. Paris: Masson; 2002.

    Google Scholar 

  8. Marani E, Pijl MEJ, Kraan MC, et al. Interconnection of the upper ventral rami of the human sacral plexus: a reappraisal for dorsal rhizotomy in neurostimulation operations. Neurourol Urodyn. 1993;12:585–98.

    Article  CAS  PubMed  Google Scholar 

  9. Jünemann K, Lue TF, Schmidt RA, et al. Clinical significance of sacral and pudendal nerve anatomy. J Urol. 1988;139:74.

    Article  Google Scholar 

  10. Gil-Vernet S. Innervation somatique et végétative des organes génito-urinaires. Acta Urol Belg. 1964;32:265–93.

    CAS  Google Scholar 

  11. Labat JJ, Robert R, Bensignor M, et al. Les névralgies du nerf pudendal (honteux interne). Considérations anatomocliniques et perspectives thérapeutiques. J Urol (Paris). 1990;96:239–44.

    CAS  Google Scholar 

  12. Vodušek DB, Light JK. The motor nerve supply of the external urethral sphincter muscles. Neurourol Urodyn. 1983;2:193–200.

    Article  Google Scholar 

  13. Vodušek DB. Anatomy and neurocontrol of the pelvic floor. Digestion. 2004;69(2):87–92.

    Article  PubMed  Google Scholar 

  14. Mohammadali M, Sharma A, Mirza N, et al. Neuroanatomy of the female abdominopelvic region: a review with application to pelvic pain syndromes. Clin Anat. 2013;26:66–76.

    Article  Google Scholar 

  15. Hoffman B, Schorge J, Schaffer J, et al. Williams gynecology. 2nd ed. New York: McGraw Hill Professional; 2012.

    Google Scholar 

  16. Benezech A, Bouvier M, Vitton V. Faecal incontinence: current knowledges and perspectives. World J Gastrointest Pathophysiol. 2016;7:59–71.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fry P, Chess-Williams R, Hashitani H, et al. Cell biology. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence: 6th International Consultation on Incontinence, Tokyo, September 2016, vol. 1. 6th ed. Bristol (UK): International Continence Society (ICS) and International Consultation on Urological Diseases (ICUD); 2017.

    Google Scholar 

  18. Remes-Troche JM, Rao SS. Neurophysiological testing in anorectal disorders. Exp Rev Gastroenterol Hepatol. 2008;2:323–35.

    Article  Google Scholar 

  19. Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004;126:S14–22.

    Article  PubMed  Google Scholar 

  20. Roberts M. Clinical neuroanatomy of the abdomen and pelvis: implications for surgical treatment of prolapse. Clin Obstet Gynecol. 2005;48(3):627–38.

    Article  PubMed  Google Scholar 

  21. Schwartzman RJ. Differential diagnosis in Neurology. Amsterdam: I.O.S. Press; 2006.

    Google Scholar 

  22. Rosenbach O. Ein Beitrag zur Symptomatologie cerebraler Hemiplegieen. Arch Psychiatr Nervenkr. 1876;6:845–51.

    Article  Google Scholar 

  23. Wartenberg R. A pinwheel for neurologic examination. JAMA. 1937;109:1294.

    Article  Google Scholar 

  24. Monrad-Krohn GH. Technique clinique d’examen complet du systeme nerveux. Paris: Librairie E. le Francois; 1925.

    Google Scholar 

  25. Mumenthaler M. Neurologic differential diagnosis. New York: Thieme Stratton; 1985.

    Google Scholar 

  26. Dick JPR. The deep tendon and the abdominal reflexes. J Neurol Neurosurg Psychiatry. 2003;74:150–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Walton JN. Brain’s diseases of the nervous system. 7th ed. Oxford: Oxford University Press; 1969.

    Google Scholar 

  28. McAlpine D, Lumsden CE, Acheson ED. Multiple sclerosis, a reappraisal. London: Livingstone; 1965.

    Google Scholar 

  29. Wartenberg R. The examination of reflexes, a simplification. Chicago: The Year book publishers; 1945.

    Google Scholar 

  30. Lehoczky T, Fodors T. Clinical significance of the dissociation of abdominal reflexes. Neurology. 1953;3:453–9.

    Article  CAS  PubMed  Google Scholar 

  31. Monrad-Krohn GH. The clinical examination of the nervous system. 3rd ed. London: HK Lewis; 1926.

    Google Scholar 

  32. Hargrove G, Bors E. The suprapubic abdominal tap reflex: a useful method to assess the function of the sacral reflex arcs. J Urol. 1972;107:243–4.

    Article  CAS  PubMed  Google Scholar 

  33. Yilmaz U, Yang CC, Berger RE. Dartos reflex: a sympathetically mediated scrotal reflex. Muscle Nerve. 2006;33(3):363–8.

    Article  PubMed  Google Scholar 

  34. Bingol-Kologlu M, Demirci M, Buyukpamukcu N, et al. Cremasteric reflexes of boys with descended, retractile, or undescended testes: an electrophysiological evaluation. J Pediatr Surg. 1999;34:430–4.

    Article  CAS  PubMed  Google Scholar 

  35. Nagy JI, Senba E. Neural relations of cremaster motoneurons, spinal cord systems and the genitofemoral nerve in the rat. Brain Res Bull. 1985;15:609–27.

    Article  CAS  PubMed  Google Scholar 

  36. Haerer A. The superficial cutaneous reflexes. In: Haerer A, editor. De Jong’s the neurologic examination. London: Lippincott; 1992.

    Google Scholar 

  37. Yang CC, Bradley WE. Somatic innervation of the human bulbocavernosus muscle. Clin Neurophysiol. 1999;110:412–8.

    Article  CAS  PubMed  Google Scholar 

  38. Schwarz GM, Hirtler L. The cremasteric reflex and its muscle—a paragon of ongoing scientific discussion: a systematic review. Clin Anat. 2017;30(4):498–507.

    Article  PubMed  Google Scholar 

  39. Rossolimo G. Der Analreflex, seine physiologie und pathologie. Neurologisches Centralblatt. 1891;4:257–9.

    Google Scholar 

  40. Cavallari P, Bolzoni F, Esposti R, et al. Cough-anal reflex may be the expression of a pre-programmed postural action. Front Hum Neurosci. 2017;11:475.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Pedersen E. Human anal reflexes. In: Henry MM, Swash M, editors. Coloproctology and the pelvic floor. London: Butterworths; 1985. p. 104–11.

    Google Scholar 

  42. Steele S, Hull T, Read T, Saclarides T, Senagore A, Whitlow C, editors. The ASCRS textbook of colon and rectal surgery. 3rd ed. Oakbrook Terrace, IL: ASCRS; 2016.

    Google Scholar 

  43. Deep Tendon Reflexes. http://stanfordmedicine25.stanford.edu/the25/tendon.html. Accessed 29 Jun 2019.

  44. Swash M, Mathers S. Sphincter disorders and the nervous system. In: Aminoff M, editor. Neurology and general medicine. New York, NY: Churchill-Livingstone; 1989.

    Google Scholar 

  45. Chan CL, Ponsford S, Swash M. The anal reflex elicited by cough and sniff: validation of a neglected clinical sign. J Neurol Neurosurg Psychiatry. 2004;75(10):1449–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Frenckner B. Function of the anal sphincters in spinal man. Gut. 1975;16:482–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Campbell WW. DeJong's the neurologic examination. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.

    Google Scholar 

  48. Chancellor M, Blaivas J. Practical neurourology: genitourinary complications in neurologic disease. Oxford: Butterworth-Heinemann; 1985.

    Google Scholar 

  49. Rattner W, Gerlaugh R, Murphy J, et al. The bulbocavernosus reflex: electromyographic study of normal patients. J Urol. 1958;80(2):140–1.

    Article  CAS  PubMed  Google Scholar 

  50. Rushton DN. Neuro-urological history and examination. In: Handbook of neuro-urology. New York, Basel, Hong Kong: Marcel Dekker; 1994.

    Google Scholar 

  51. Bors E, Blinn KA. Bulbocavernosus reflex. J Urol. 1959;82(1):128–30.

    Article  CAS  PubMed  Google Scholar 

  52. Wester C, FitzGerald MP, Brubaker L, et al. Validation of the clinical bulbocavernosus reflex. Neurourol Urodyn. 2003;22(6):589–91.

    Article  CAS  PubMed  Google Scholar 

  53. Blaivas JG, Chancellor MB. Neuro-urologic examination. In: Chancellor MB, Blaivas JG, editors. Practical neuro-urology. Genitourinary complications in neurologic disease. Boston, Oxford: Butterworth-Heinemann; 1995.

    Google Scholar 

  54. Khullar V, Cardozo L. History and examination. In: Cardozo L, Staskin D, editors. Textbook of female urology and urogynaecology. London: ISIS Medical Media; 2001.

    Google Scholar 

  55. Stanton SL. History and examination. In: Stanton SL, Monga AK, editors. Clinical urogynaecology. 2nd ed. London: Churchill Livingstone; 2000.

    Google Scholar 

  56. Blaivas JG, Zayed AA, Labib KB. The bulbocavernosus reflex in urology: a prospective study of 299 patients. J Urol. 1981;126:197–9.

    Article  CAS  PubMed  Google Scholar 

  57. Bobbitt JM, Lapides J. Diagnostic value of bulbocavernosus reflex. J Am Med Assoc. 1956;162(10):971–2.

    Article  CAS  PubMed  Google Scholar 

  58. Constantinou CE, Govan DE. Spatial distribution and timing of transmitted and reflexly generated urethral pressures in healthy women. J Urol. 1982;127(5):964–9.

    Article  CAS  PubMed  Google Scholar 

  59. Craggs MD, Balasubramaniam AV, Chung EA, et al. Aberrant reflexes and function of the pelvic organs following spinal cord injury in man. Auton Neurosci. 2006;126:355–70.

    Article  PubMed  Google Scholar 

  60. Dietz HP, Erdmann M, Shek KL. Reflex contraction of the levator ani and external perineal muscles in women symptomatic for pelvic floor disorders. Ultrasound Obstet Gynecol. 2012;40:215–8.

    Article  CAS  PubMed  Google Scholar 

  61. Enck P, Vodusek DB. Electromyography of pelvic floor muscles. J Eletromyogr Kinesiol. 2006;16:568–77.

    Article  Google Scholar 

  62. Amarenco G, Ismael S, Lagauche D, et al. Cough anal reflex: strict relationship between intravesical pressure and pelvic floor muscle electromyographic activity during cough. Urodynamic and electrophysiological study. J Urol. 2005;173:149–52.

    Article  PubMed  Google Scholar 

  63. Deffieux X, Raibaut P, Rene-Corail P, et al. External anal sphincter contraction during cough: not a simple spinal reflex. Neurourol Urodyn. 2006;25:782–7.

    Article  PubMed  Google Scholar 

  64. Chancellor MB, Perkin H, Yoshimura N. Recent advances in the neurophysiology of stress urinary incontinence. Scand J Urol Nephrol. 2005;39:21–4.

    Article  PubMed  Google Scholar 

  65. Siroky MB, Krane RJ. Neurologic aspects of detrusor-sphincter dyssynergia, with reference to the guarding reflex. J Urol. 1982;127:953–7.

    Article  CAS  PubMed  Google Scholar 

  66. Rudy DC, Awad SA, Downie JW. External sphincter dyssynergia: an abnormal continence reflex. J Urol. 1988;140:105–10.

    Article  CAS  PubMed  Google Scholar 

  67. Park JM, Bloom DA, McGuire EJ. The guarding reflex revisited. Br J Urol. 1997;80(6):940–5.

    Article  CAS  PubMed  Google Scholar 

  68. Fynne L, Luft F, Gregersen H, et al. Distensibility of the anal canal in patients with systemic sclerosis: a study with the functional lumen imaging probe. Color Dis. 2013;15(1):e40–7.

    Article  CAS  Google Scholar 

  69. Mannen T, Iwata M, Toyokura Y, et al. The Onuf's nucleus and the external anal sphincter muscles in amyotrophic lateral sclerosis and Shy-Drager syndrome. Acta Neuropathol. 1982;58:255–60.

    Article  CAS  PubMed  Google Scholar 

  70. DeJong RN. The neurologic examination. 4th ed. New York: Paul B. Hoeber; 1958.

    Google Scholar 

  71. Monrad-Krohn GH, Refsum S. The clinical examination of the nervous system. 12th ed. London: H.K. Lewis; 1964.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Donatella Giraudo .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Giraudo, D., Verderosa, F. (2020). Reflex Testing and Pelvic Examination. In: Lamberti, G., Giraudo, D., Musco, S. (eds) Suprapontine Lesions and Neurogenic Pelvic Dysfunctions. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-030-29775-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-29775-6_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-29774-9

  • Online ISBN: 978-3-030-29775-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics