Prevalence of pudendal neuropathy in fecal incontinence |
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Authors: | Dr José V Roig MD Carlos Villoslada MD Salvador Lledó MD Amparo Solana MD Elvira Buch MD Rafael Alós MD Joaquín Hinojosa MD |
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Institution: | (1) Department of Surgery, Hospital de Sagunto, Avda. Ramón y Cajal s/n, 46520 Sagunto, Valencia, Spain;(2) Department of Neurophysiology, Hospital de Sagunto, Valencia, Spain;(3) Department of Gastroenterology, Hospital de Sagunto, Valencia, Spain;(4) Department of Surgery, Hospital Clínico Universitario, Valencia, Spain |
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Abstract: | PURPOSE: A prospective study was made of the prevalence and associations of pudendal neuropathy in 96 patients with fecal incontinence (72 females and 24 males). METHODS: Clinical exploration, perineal level measurement, anorectal manometry, and electrophysiologic evaluations (pudendal nerve terminal motor latency (PNTML) and external sphincter fiber density (FD)) were performed. RESULTS: Pudendal neuropathy (defined as PNTML>2.2 ms or FD>1.65) was found in 67 patients (69.8 percent) and was more common in females (75 percent) than in males (50 percent;P
= 0.05). Pudendal neuropathy was also more frequent in patients with pathologic perineal descent (85 percent
vs.
55 percent;P
<0.01) or exhibiting risk factors such as difficult labor or excessive defecatory straining (P
<0.01). Perineal level at straining correlated inversely with both PNTML and FD (P
<0.01). Manometric findings suggested greater external anal sphincter damage in patients with pudendal neuropathy than in those suffering fecal incontinence but no neuropathy (P
<0.05). Pressure caused by the striated anal sphincter was also inversely correlated to PNTML. Pudendal neuropathy was encountered in 37 of 63 (58.7 percent) patients with sphincter injury
vs.in 31 of 33 (93.9 percent) patients with idiopathic fecal incontinence (P
< 0.01). CONCLUSIONS: Pudendal neuropathy is an etiologic or associated factor often present in patients with fecal incontinence. In this sense, clinical, perineometric, and manometric findings correlate with pudendal neuropathy, though such explorations do not suffice to detect it.Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994. |
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Keywords: | Fecal incontinence Pudendal neuropathy Anal sphincter |
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