THE ACUTE EFFECT OF STRAINING ON PELVIC FLOOR NEUROLOGICAL FUNCTION

被引：32

作者：

ENGEL, AF ^{[1
]}

KAMM, MA ^{[1
]}

机构：

[1] ST MARKS HOSP,SIR ALAN PARKS PHYSIOL UNIT,LONDON EC1V 2PS,ENGLAND

来源：

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE | 1994年 / 9卷 / 01期

关键词：

D O I：

10.1007/BF00304293

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Integrity of sensory and motor function is essential in the maintenance of continence. The pudendal nerve assumes a central role being a mixed sensory and motor nerve. Neuropathic changes may therefore lead to incontinence and stretch injury to the pudendal nerve has been implicated as an aetiological factor. However pudendal neuropathy, altered anal sensation and perineal descent do not always correlate in the same patient. To investigate this further we evaluated the effect of a simulated defaecation strain on pelvic floor neurological function in a group of patients with constipation and incontinence. Pudendal nerve terminal motor latency (PNTML) and anal electrosensitivity (AS) were measured at rest and after a simulated defaecation strain of 1 minute. At rest PNTML correlated with AS (r = 0.461, P = 0.003). Twenty-five patients had perineal descent of more than 1 cm on straining, and 13 had descent below the ischial tuberosities. After 1 minute of straining AS was significantly (P < 0.001) blunted and PNTML was significantly (P < 0.001) prolonged both changes returning to normal after 3 minutes. AS was significantly (P = 0.01) more blunted in patients with perineal descent of more than 1 cm. PNTML was significantly (P = 0.01) more prolonged in patients with perineal descent of more than 2 cm. Age was significantly correlated with AS (r = 0.45, P = 0.004) and PNTML (r = 0.49, P = 0.002). Anal sensation and PNTML are acutely affected by defaecation straining, and changes may occur in patients without perineal descent. Functional changes occur equally in constipated and incontinent patients.

引用

页码：8 / 12

页数：5

共 22 条

[1]

Parks A.G., Swash M., Ulrich H., Sphincter denervation in anorectal incontinence and rectal prolapse, Gut, 18, pp. 656-665, (1977)

[2]

Beersiek F., Parks A.G., Swash M., Pathogenesis of anorectal incontinence: a histometric study of the anal canal musculature, J Neurol Sci, 42, pp. 111-127, (1979)

[3]

Swash M., Gray A., Lubowski D.Z., Nicholls R.J., Ultrastructural changes in internal sphincter in neurogenic incontinence, Gut, 29, pp. 1692-1698, (1988)

[4]

Rogers J., Henry M.M., Misiewicz J.J., Combined sensory and motor deficit in primary faecal incontinence, Gut, 29, pp. 5-9, (1988)

[5]

Speakman C.T.M., Kamm M.A., Abnormal visceral autonomic innervation in neurogenic faecal incontinence, Gut, 34, pp. 215-221, (1993)

[6]

Snooks S.J., Swash M., Setchell M., Injury to the innervation of pelvic floor sphincter musculature in childbirth, Lancet, 2, pp. 546-550, (1984)

[7]

Kiff E.S., Barnes P.R.H., Swash M., Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool, Gut, 25, pp. 1279-1282, (1984)

[8]

Kiff E.S., Swash M., Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence, Br J Surg, 1984, pp. 614-616, (1984)

[9]

Jones P.N., Lubowski D.Z., Swash M., Henry M.M., Relation between perineal descent and pudendal nerve damage in idiopathic faecal incontinence, Int J Colorect Dis, 2, pp. 93-95, (1987)

[10]

Henry M.M., Parks A.G., Swash M., The pelvic floor musculature in the descending perineum syndrome, Br J Surg, 69, pp. 470-472, (1982)

← 1 2 3 →