Elektromyographisches aktivit�tsverhalten des M. sphincter ani externus und M. puborectalis im def�kationstest bei patienten mit obstruktiven Entleerungsst�rungen

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.

Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia on Diagnosis and Treatment of Constipation in Adults

“…• Пациентам с подозрением на диссинергию мышц тазового дна с целью подтверждения диагноза рекомендуется проведение суммарной электромиографии (ЭМГ) наружного анального сфинктера или тазового дна для диагностики структурных и функциональных нарушений [11].…”

“…• Пациентам с подозрением на наличие функциональных расстройств дефекации, проявляющихся в том числе диссинергией мышц тазового дна, с целью подтверждения диагноза рекомендовано проведение аноректальной манометрии (в том числе манометрии высокого разрешения и/или интерференционной внутрианальной ЭМГ c дополнительным выполнением теста на эвакуацию баллона при попытке натуживания (эвакуаторная проба) [11].…”

Def�koflowmetrie Eine neue Untersuchungstechnik zur beurteilung der entleerungsfunktion des rektums

“…Die bis heute angewandten funktionellen Untersuchungen mit dem Ziel, den genauen Def~ikationsablauf und seine Mechanismen zu erfassen, waren unzureichend. Dies gilt auch ftir Kombinationsverfahren [1,3,4,7,22,39].…”

Die Entleerungsdefäkographie und die Defäkoflowmetrie in der Diagnostik der chronischen Obstipation Eine prospektiv vergleichende Studie bei 49 Patienten

“…Zu den einfachen und leicht wiederholbaren Basisuntersuchungen gehören neben der Endoskopie die manometrische Chirurg (1998) [2,3]. des Untersuchungsvorgangs als auch der Interpretation der erhobenen Befunde.…”