Abstract
PURPOSE: This study was undertaken to determine the role of abnormal distal rectoanal excitatory reflex (RAER) as a marker of pudendal neuropathy and to compare results with pudendal nerve terminal motor latency (PNTML) and single fiber density (SFD) estimation. METHODS: Fifteen female patients (mean age, 47.1 (range, 20–70) years) referred to the pelvic floor laboratory with pelvic floor disorders (fecal incontinence, 13 patients; constipation, 2 patients) were evaluated prospectively with neurophysiologic tests and balloon reflex manometry for evidence of pudendal neuropathy. RESULTS: Pudendal nerve terminal motor latency provided evidence of pudendal neuropathy in ten patients (67 percent) and was normal in five patients (33 percent). Increased SFD confirmed denervation of the external anal sphincter in 12 patients (80 percent), being normal in 3 patients (20 percent). Distal RAER was abnormal in 13 patients (87 percent) and was normal in 2 patients (13 percent). In ten patients (67 percent), the three diagnostic modalities were in complete agreement, correctly identifying neuropathy in nine patients (60 percent) and excluding nerve damage in one patient (7 percent). Distal RAER was normal despite prolonged PNTML and increased SFD in one patient (7 percent). In two patients (13 percent), distal RAER was abnormal or absent despite normal PNTML and SFD. Pudendal nerve terminal motor latency was normal in the presence of abnormal distal RAER and increased SFD on electromyography in two patients (13 percent). CONCLUSIONS: Abnormal distal RAER compares favorably with current neurophysiologic tests used to diagnose pudendal neuropathy.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Kiff ES, Swash M. Slowed conduction in pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.
Neill ME, Swash M. Increased motor unit fibre density in the external sphincter muscle in ano-rectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 1980;43:343–7.
Sangwan YP, Coller JA, Barrett RC, Murray JJ, Roberts PL, Schoetz DJ Jr. Distal rectoanal excitatory reflex: a reliable index of pudendal neuropathy? Dis Colon Rectum 1995;38:916–20.
Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am 1987;16:17–33.
Roberts PL. Principles of manometry. Semin Colon Rectal Surg 1992;3:64–7.
Sangwan YP, Coller JA, Schoetz DJ Jr, Roberts PL, Murray JJ. Spectrum of abnormal rectoanal reflex patterns in patients with fecal incontinence. Dis Colon Rectum 1996;39:59–65.
Author information
Authors and Affiliations
About this article
Cite this article
Sangwan, Y.P., Coller, J.A., Barrett, R.C. et al. Prospective comparative study of abnormal distal rectoanal excitatory reflex, pudendal nerve terminal motor latency, and single fiber density as markers of pudendal neuropathy. Dis Colon Rectum 39, 794–798 (1996). https://doi.org/10.1007/BF02054446
Issue Date:
DOI: https://doi.org/10.1007/BF02054446