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Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence.
Dis Colon Rectum. 2015 Dec; 58(12):1186-93.DC

Abstract

BACKGROUND

Conscious external anal sphincter contraction is mediated by the pudendal nerve. Pudendal neuropathy is, therefore, believed to result in fecal incontinence. Until urge sensation is experienced, fecal continence is maintained by unconscious external anal sphincter contraction, which is regulated by the anal-external sphincter continence reflex. The innervation of unconscious contraction is yet unknown.

OBJECTIVE

We aimed to determine whether unconscious contraction is mediated by the pudendal nerve and whether age influences unconscious contraction.

DESIGN

This was a retrospective comparative study.

SETTINGS

The study was conducted in a tertiary care center.

PATIENTS

Seventy adult patients experiencing defecation problems who underwent anorectal function tests were included in this study.

MAIN OUTCOME MEASURES

Conscious and unconscious contractions were compared between patients with and without pudendal neuropathy. Conscious contraction was defined by maximum anal sphincter contractility, unconscious contraction by pressure in the anal canal at maximum tolerable or retainable sensation during the balloon retention test.

RESULTS

Unconscious contraction did not differ significantly between patients with pudendal neuropathy and non-pudendal neuropathy patients, whereas conscious contraction was significantly lower in patients with pudendal neuropathy. Multiple linear regression analyses demonstrated that unconscious contraction, in contrast to conscious contraction, was not predicted significantly by age and anal electrosensitivity at 2 cm, which represents pudendal neuropathy. Patients with pudendal neuropathy were significantly older than patients with nonpudendal neuropathy.

LIMITATIONS

The pudendal nerve motor latency and EMG tests were not performed.

CONCLUSIONS

The pudendal nerve does not mediate unconscious external anal sphincter contraction. Pudendal neuropathy alone, therefore, results in urge incontinence rather than in complete fecal incontinence. Unconscious contraction appears not to be influenced by age. Therefore, most of the elderly patients experience urge incontinence rather than complete fecal incontinence.

Authors+Show Affiliations

1 Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands 2 Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26544817

Citation

van Meegdenburg, Maxime M., et al. "Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence." Diseases of the Colon and Rectum, vol. 58, no. 12, 2015, pp. 1186-93.
van Meegdenburg MM, Heineman E, Broens PM. Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence. Dis Colon Rectum. 2015;58(12):1186-93.
van Meegdenburg, M. M., Heineman, E., & Broens, P. M. (2015). Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence. Diseases of the Colon and Rectum, 58(12), 1186-93. https://doi.org/10.1097/DCR.0000000000000497
van Meegdenburg MM, Heineman E, Broens PM. Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence. Dis Colon Rectum. 2015;58(12):1186-93. PubMed PMID: 26544817.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence. AU - van Meegdenburg,Maxime M, AU - Heineman,Erik, AU - Broens,Paul M A, PY - 2015/11/7/entrez PY - 2015/11/7/pubmed PY - 2016/2/13/medline SP - 1186 EP - 93 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 58 IS - 12 N2 - BACKGROUND: Conscious external anal sphincter contraction is mediated by the pudendal nerve. Pudendal neuropathy is, therefore, believed to result in fecal incontinence. Until urge sensation is experienced, fecal continence is maintained by unconscious external anal sphincter contraction, which is regulated by the anal-external sphincter continence reflex. The innervation of unconscious contraction is yet unknown. OBJECTIVE: We aimed to determine whether unconscious contraction is mediated by the pudendal nerve and whether age influences unconscious contraction. DESIGN: This was a retrospective comparative study. SETTINGS: The study was conducted in a tertiary care center. PATIENTS: Seventy adult patients experiencing defecation problems who underwent anorectal function tests were included in this study. MAIN OUTCOME MEASURES: Conscious and unconscious contractions were compared between patients with and without pudendal neuropathy. Conscious contraction was defined by maximum anal sphincter contractility, unconscious contraction by pressure in the anal canal at maximum tolerable or retainable sensation during the balloon retention test. RESULTS: Unconscious contraction did not differ significantly between patients with pudendal neuropathy and non-pudendal neuropathy patients, whereas conscious contraction was significantly lower in patients with pudendal neuropathy. Multiple linear regression analyses demonstrated that unconscious contraction, in contrast to conscious contraction, was not predicted significantly by age and anal electrosensitivity at 2 cm, which represents pudendal neuropathy. Patients with pudendal neuropathy were significantly older than patients with nonpudendal neuropathy. LIMITATIONS: The pudendal nerve motor latency and EMG tests were not performed. CONCLUSIONS: The pudendal nerve does not mediate unconscious external anal sphincter contraction. Pudendal neuropathy alone, therefore, results in urge incontinence rather than in complete fecal incontinence. Unconscious contraction appears not to be influenced by age. Therefore, most of the elderly patients experience urge incontinence rather than complete fecal incontinence. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/26544817/Pudendal_Neuropathy_Alone_Results_in_Urge_Incontinence_Rather_Than_in_Complete_Fecal_Incontinence_ L2 - https://doi.org/10.1097/DCR.0000000000000497 DB - PRIME DP - Unbound Medicine ER -