Pudendal Neuropathy in Evacuatory Disorders

CARLOS A. VACCARO; DEMIS M. O. CHEONG; STEVEN D WEXNER; JUAN J. NOGUERAS; SALANGA VD; HANSON MR; PHILLIPS RC

DISEASES OF THE COLON AND RECTUM.

LIPPINCOTT WILLIAMS & WILKINS

Lugar: Philadelphia; Año: 1995

0012-3706

PURPOSE: Aims of the present study were to assess fre- quency of pudendal neuropathy in patients with constipa- tion and fecal incontinence, to determine its correlation with clinical variables, anal electromyographic assess- ment, and anal manometric pressures, and to determine usefulness of the pudendal nerve terminal motor latency assessment in evaluation of these evacuatory disorders. METHODS: From 1988 to 1993, 395 patients (constipated, 172; incontinent, 223) underwent pudendal nerve terminal motor latency, electromyography, and anal manometry. Pu- dendal neuropathy was defined as a pudendal nerve termi- nal motor latency greater than 2.2 ms. RESULTS: Patients were a mean age of 60.7 (range, 17-88) years. Overall incidence of pudendal neuropathy was 31.4 percent (con- stipated, 23.8 percent; incontinent, 37.2 percent; P < 0.05). Incidence of pudendal neuropathy dramatically increased after 70 years of age in both groups (22 percent vs. 44 percent; P < 0.05). Moreover, subjects with pudendal neu- ropathy were older than those without pudendal neuropa- thy (mean age, 67 vs. 57 years; P < 0.05). The presence of pudendal neuropathy was associated with decreased motor unit potentials recruitment in patients with incontinence (P < 0.01). Patients with and without pudendal neuropathy had a similar mean squeezing pressure in both groups. CONCLUSION: Pudendal neuropathy is an age-related phe- nomenon. Mthough pudendal neuropathy is associated with abnormal anal electromyographic findings in patients with incontinence, no association with anal manometric pressures was found. Pudendal nerve terminal motor la- tency assessment is a useful tool in the evaluation of pa- tients with fecal incontinence, but its role in the assessment of constipated patients remains unknown.