Abstract
A prospective study was undertaken to evaluate pudendal neuropathy in fecal incontinence. Fifty-two patients (38 women and 14 men) with fecal incontinence underwent manometric and electromyographic evaluation (measurement of pudendal nerve terminal motor latency [PNTML] and sphincter muscle mapping). The average age of all patients was 54±17 years. Fifty-two percent (27/52) were found to have a pudendal neuropathy (PNTML > 2.1 milliseconds). Seventeen of these 27 patients (63 percent) had a bilateral pudendal neuropathy. Patients with a pudendal neuropathy were older than those without a neuropathy (63.7 years vs.51.9 years;P =0.01). Women were significantly more likely than men to have a pudendal neuropathy (P =0.03). Nine patients had an anatomic sphincter defect identified, and six of these (67 percent) had a neuropathy; 4/6 (67 percent) had a bilateral pudendal neuropathy. In the 43 patients who did not have an anatomic sphincter defect, there was no difference in resting pressure (69 mmHg vs 60 mmHg;P = 0.4) or maximum voluntary contraction (95 mmHg vs.86 mmHg;P =0.5) when patients without a neuropathy were compared with those with a neuropathy. Patients with a pudendal neuropathy had a shorter sphincter length than those without a neuropathy (3.0 cm vs.3.9 cm;P =0.01). Bilateral pudendal neuropathy tended to occur more frequently in women (P =0.08) and was not associated with poorer resting pressure, maximum voluntary contraction, or shorter sphincter length. We conclude that pudendal neuropathy is a common cause of fecal incontinence, particularly in older women, and frequently occurs in association with a sphincter defect. Manometric evaluation alone is not helpful in identifying the neuropathic patient. PNTMLs should be routinely measured in the evaluation of fecal incontinence.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.
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Vernava, A.M., Longo, W.E. & Daniel, G.L. Pudendal neuropathy and the importance of EMG evaluation of fecal incontinence. Dis Colon Rectum 36, 23–27 (1993). https://doi.org/10.1007/BF02050297
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DOI: https://doi.org/10.1007/BF02050297