Strength-Duration Testing of the External Anal Sphincter in Females with Anorectal Dysfunction

Mills, Pauline M; Hosker, G. L.; Kiff, E. S.; Smith, Anthony

doi:10.1007/s10350-004-6118-z

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…Although there was a high incidence (32%) of anterior EAS defects detected on endoanal ultrasound, this cannot fully explain our results, as there was no significant difference in energy requirement between patients with intact EAS and those with defects in this stimulus position. Although no correlation was seen between the SDT at 3 o'clock and the left PNTML, our study size was smaller than previous research into the SDT [4,5] and no significant difference was identified in the SDCs produced at the 3 and 9 o'clock positions. These points closely correspond to where the pudendal nerves enter the EAS.…”

Section: Discussioncontrasting

confidence: 72%

“…However, six had to withdraw due to unforeseen circumstances. More patients stopped the test because of pain than has been previously reported [4,5], though the majority of those women were able to tolerate the SDT at least once. On the whole patients found the test acceptable.…”

Section: Discussionmentioning

confidence: 94%

“…Mills et al. [5] found good correlation between the SDT and established measures of EAS function and innervation. The SDT may in fact be more sensitive than pudendal nerve terminal motor latency (PNTML) in detecting neuropathy of the EAS in women with intact but weak sphincters [6].…”

Section: Introductionmentioning

confidence: 99%

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Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction

Telford¹,

Grey²,

Mackenzie³

et al. 2006

Colorectal Disease

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 94%

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Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction

Telford¹,

Grey²,

Mackenzie³

et al. 2006

Colorectal Disease

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“…A detailed medical and obstetric history was obtained from the patients. Anal manometry, PNTML and EAUS [7] have been previously described and were performed by a trained technician.…”

Section: Study Groupmentioning

confidence: 99%

“…The two groups had entirely different SDCs and it suggested that the test might have a useful role in the assessment of EAS function. Subsequently, we [7] identified weak but appropriate correlations between the SDT and other physiological measurements of EAS function.…”

Section: Introductionmentioning

confidence: 96%

The strength duration test: a novel tool in the identification of occult neuropathy in women with pelvic floor dysfunction

et al. 2004

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To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

Dekker

Reijn-Baggen

Han-Geurts

et al. 2023

Int J Colorectal Dis

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Background Anorectal function tests are helpful for objective investigation of anorectal (dys)function. A variety of tests are available, but there is no recommendation when to perform which test. Furthermore, which test is the most accurate is controversial and the correlation between these tests is not very clear. The aim of our study was to examine the correlation of anal pressures and the possibility to diagnose pelvic floor dyssynergia between digital rectal examination (DRE) and several anorectal function tests. Methods Between January 2020 and April 2022, all men and women aged 18 to 80 years, treated at the Proctos Clinic, who were referred for pelvic floor physical therapy (PFPT) by the surgeon and underwent anorectal function tests, were included. DRE was performed to establish the anal pressure at rest and during squeeze and straining. Anorectal function tests included 3D high-resolution anal manometry (3D-HRAM), balloon expulsion test (BET), transperineal ultrasound (TPUS), and surface electromyography (s-EMG). Results A total of 50 patients, 37 (74%) females, were included. Median age was 51 years. Twenty-three (62%) females had a history of two or more vaginal deliveries. The most frequent reason for referral for PFPT was fecal incontinence in 27 (54%) patients. The assessed pressures and pelvic floor function measured with DRE by the surgeon and the pelvic floor physical therapist during rest, squeeze, and straining correlated in 78%, 78%, and 84%, respectively. Correlation between DRE and 3D-HRAM or s-EMG was better for squeeze pressures than resting pressures. The correlation between s-EMG and 3D-HRAM was better during squeeze than at rest with an agreement of 59% and 37%, respectively. Conclusion DRE by an experienced investigator is of sufficient value for daily clinical practice to detect dyssynergia and to measure sphincter tone. Commonly performed anorectal function tests correlate poorly with DRE and with other anorectal function tests. When conservative treatment fails, further investigation is warranted; however, these results should be interpreted with caution. What does this paper add to the literature? Anorectal function tests such as the 3D high-resolution anorectal manometry, balloon expulsion test, surface electromyography, and transperineal ultrasound are all frequently performed in the diagnostic workup in patients with defecation disorders. No previous study has compared these tests regarding their outcomes, nor has the interrater agreement been measured regarding the digital rectal examination by two experienced observers. Furthermore, transperineal ultrasound is in all probability not frequently used and therefore underexposed in the diagnostic workup of patients with dyssynergic defecation.

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Strength-Duration Testing of the External Anal Sphincter in Females with Anorectal Dysfunction

Abstract: The strength-duration test significantly correlates with the established measures of external anal sphincter function and its innervation. Therefore, this simple test appears to provide a simple measure of external anal sphincter denervation.

Cited by 6 publications

References 7 publications

Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction

Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction

The strength duration test: a novel tool in the identification of occult neuropathy in women with pelvic floor dysfunction

To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

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