Striated anal sphincter electromyography in idiopathic fecal incontinence

Infantino, A.; Melega, Enrico; Negrin, P; Masin, Lessandra; Carnio, Silvia; Lise, Mario

doi:10.1007/bf02053853

Cited by 22 publications

(8 citation statements)

References 16 publications

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“…Indeed, 18 of 20 controls were normal by semiquantitative analysis; one control each had nonspecific abnormalities and features of neurogenic injury. None of the four patients who had nonspecific changes by semiquantitative analysis had reduced recruitment, which is the most specific feature of neurogenic injury, and has been associated with lower anal squeeze pressures previously (14,20,26).…”

Section: Discussionmentioning

confidence: 79%

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Bharucha¹,

Daube²,

Litchy³

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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Bharucha AE, Daube J, Litchy W, Traue J, Edge J, Enck P, Zinsmeister AR. Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence. Am J Physiol Gastrointest Liver Physiol 303: G256 -G262, 2012. First published May 4, 2012 doi:10.1152/ajpgi.00099.2012.-While anal sphincter neurogenic injury documented by needle electromyography (EMG) has been implicated to cause fecal incontinence (FI), most studies have been uncontrolled. Normal values and the effects of age on anal sphincter motor unit potentials (MUP) are ill defined. The functional significance of anal sphincter neurogenic injury in FI is unclear. Anal pressures and EMG were assessed in 20 asymptomatic nulliparous women (age, 38 Ϯ 5 yr; mean Ϯ SE) and 20 women with FI (54 Ϯ 3 yr). A computerized program quantified MUP duration and phases. These parameters and MUP recruitment were also semiquantitatively assessed by experienced electromyographers in real time. Increasing age was associated with longer and more polyphasic MUP in nulliparous women by quantitative analysis. A higher proportion of FI patients had prolonged (1 control, 7 patients, P ϭ 0.04) and polyphasic MUP (2 controls, 9 patients, P ϭ 0.03) at rest but not during squeeze. Semiquantitative analyses identified neurogenic or muscle injury in the anal sphincter (11 patients) and other lumbosacral muscles (4 patients). There was substantial agreement between quantitative and semiquantitative analyses ( statistic 0.63 Ϯ 95% CI: 0.32-0.96). Anal resting and squeeze pressures were lower (P Յ 0.01) in FI than controls. Anal sphincter neurogenic or muscle injury assessed by needle EMG was associated (P ϭ 0.01) with weaker squeeze pressures (83 Ϯ 10 mmHg vs. 154 Ϯ 30 mmHg) and explained 19% (P ϭ 0.01) of the variation in squeeze pressure. Anal sphincter MUP are longer and more polyphasic in older than younger nulliparous women. Women with FI have more severe neurogenic or muscle anal sphincter injury, which is associated with lower squeeze pressures. aging; electromyography; pudendal neuropathy INITIALLY DOCUMENTED BY HISTOLOGICAL evidence of sphincter denervation (27), the concept that pudendal nerve injury contributes to anal weakness in fecal incontinence (FI) gained traction when prolonged pudendal nerve terminal motor latencies were documented in FI and after obstetric anal sphincter injury (2, 22, 30). However, prolonged pudendal nerve latencies are flawed markers of pudendal nerve function (13). Hence, needle electromyography (EMG) is the only technique that can reliably identify anal sphincter neurogenic injury that can result from damage to the sacral spinal cord, cauda equina, S2-4 spinal nerves, the pudendal nerve, or its branches as they enter the anal sphincter (28,29,34). Anal sphincter EMG can also identify local muscle trauma (3). However, anal sphincter EMG is not widely available and infrequently used, mainly when neurogenic injury is suspected, in clinical practice. Also, based on limited data that suggest that anal sphincter denervation predicts poore...

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Section: Discussionmentioning

confidence: 79%

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Bharucha¹,

Daube²,

Litchy³

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Anorectal manometry was also undertaken when the implant was activated in order to check that it was functioning. Manometric findings in the series were compared with our laboratory reference values [ 11]: maximum pressure at rest was lower than the reference values in five out of eight cases, and maximum pressure at contraction was lower in all cases.…”

Section: Methodsmentioning

confidence: 99%

Artificial bowel sphincter (ABS) for severe faecal incontinence: a clinical and manometric study

et al. 2000

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“…110 Anal sphincter denervation can be encountered in fecal incontinence secondary to anal nerve or sacral root lesion. 50 The term anal nerve refers in the present text to all motor nerve branches innervating the external anal sphincter. The motor nerve branches innervating the external anal sphincter arise directly from the sacral plexus (via the inferior rectal nerve) or indirectly from the pudendal nerve (via a posterior branch before its division into the perineal nerve and an anterior branch from the perineal nerve).…”

Section: Anal Sphincter Electromyographymentioning

confidence: 99%

Neurophysiological testing in anorectal disorders

Lefaucheur

2005

Muscle and Nerve

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The neurophysiological techniques currently available to evaluate anorectal disorders include concentric needle electromyography (EMG) of the external anal sphincter, anal nerve terminal motor latency (TML) measurement in response to transrectal electrical stimulation or sacral magnetic stimulation, motor evoked potentials (MEPs) of the anal sphincter to transcranial magnetic cortical stimulation, cortical recording of somatosensory evoked potentials (SEPs) to anal nerve stimulation, quantification of electrical or thermal sensory thresholds (QSTs) within the anal canal, sacral anal reflex (SAR) latency measurement in response to pudendal nerve or perianal stimulation, and perianal recording of sympathetic skin responses (SSRs). In most cases, a comprehensive approach using several tests is helpful for diagnosis: needle EMG signs of sphincter denervation or prolonged TML give evidence for anal motor nerve lesion; SEP/QST or SSR abnormalities can suggest sensory or autonomic neuropathy; and in the absence of peripheral nerve disorder, MEPs, SEPs, SSRs, and SARs can assist in demonstrating and localizing spinal or supraspinal disease. Such techniques are complementary to other methods of investigation, such as pelvic floor imaging and anorectal manometry, to establish the diagnosis and guide therapeutic management of neurogenic anorectal disorders.

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Striated anal sphincter electromyography in idiopathic fecal incontinence

Abstract: Clinical severity of fecal incontinence is correlated with some manometric parameters. Severity of denervation of the anal striated sphincters does not appear to influence severity of fecal incontinence.

Cited by 22 publications

References 16 publications

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Artificial bowel sphincter (ABS) for severe faecal incontinence: a clinical and manometric study

Neurophysiological testing in anorectal disorders

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