The role of pelvic neuropathy in the pathogenesis of anal incontinence in patients with pelvic organ prolapse


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective. To assess the presence of pudendal neuropathy (PN) and to determine its possible role in the pathogenesis of fecal incontinence in patients with pelvic organ prolapse. Subjects and methods. Fifty-two patients with pelvic organ prolapse were examined. For diagnosis of PN, stimulation intravaginal electromyography was performed by applying St. Mark’s electrode. The complex sphincterometric technique devised at the A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia, was used to diagnose anal sphincter dysfunction (ASD). Results. Increased pudendal nerve conduction was reported in 84% of the patients with genital prolapse. All the patients with rectal prolapse were found to have neuropathy and clinical and instrumental signs of ASD. The latter signs of ASD were absent in only 8% of the women with genital prolapse; latent anal incontinence was identified in 16%, which is confirmed by the data of functional studies. Conclusion. In patients with descent and/or prolapse of the internal genitalia, the significant detection rate of neuropathy raises the question about the site of neuropathy in the pathogenesis of pelvic organ prolapse.

Full Text

Restricted Access

About the authors

Oksana Yu. Fomenko

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia

Email: info@gnck.ru; oksana671@yandex.ru
MD, Associate Professor, Head of the Laboratory of Clinical Pathophysiology

Alexander A. Popov

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: E-maihgyn_endoscopy@mail.ru
MD, professor, head of the department of endoscopic surgery

Oleg M. Biryukov

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia

Email: info@gnck.ru
candidate of medical sciences, head of the department of general and reconstructive coloproctology

Vladimir A. Kozlov

National Research University Higher School of Economics Institute of Demography

NS Laboratory of Socio-Demographic Policy, Associate Professor, Department of Demography, Institute of Demography

Anton A. Fedorov

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: gyn_endoscopy@mail.ru
candidate of medical sciences, senior researcher Department of Endoscopic Surgery

Svetlana V. Belousova

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia

Email: info@gnck.ru
candidate of medical sciences, senior researcher Laboratory of Clinical Pathophysiology

Denis V. Aleshin

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia

Email: info@gnck.ru
candidate of medical sciences, head of the operblok

Andrey A. Mudrov

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia

Email: info@gnck.ru
candidate of medical sciences, scientist Department of General and Reconstructive Coloproctology

Elena S. Efremova

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: gyn_endoscopy@mail.ru
Department of Endoscopic Surgery

Maxim A. Nekrasov

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia

Email: info@gnck.ru
M.S. Laboratory of Clinical Pathophysiology

References

  1. Pfeifer J., Salanga V.D., Agachan F., Weiss E.G., Wexner S.D. Variation in pudendal nerve terminal motor latency according to disease. Dis. Colon Rectum. 1997; 40(1): 79-83. https://dx.doi.org/10.1007/bf02055686.
  2. Osterberg A., Graf W., Edebol Eeg-Olofsson K., Hynninen P., Pahlman L. Results of neurophysiologic evaluation in fecal incontinence. Dis. Colon Rectum. 2000; 43(9): 1256-61. https://dx.doi.org/10.1007/bf02237432.
  3. Birnbaum E.H., Stamm L., Rafferty J.F., Fry R.D., Kodner I.J., Fleshman J.W. Pudendal nerve terminal motor latency influences surgical outcome in treatment of rectal prolapse. Dis. Colon Rectum. 1996; 39(11): 1215-21. https://dx.doi. org/10.1007/bf02055111.
  4. Roig J.V., Buch E., Aids R., Solana A., Fernandez C., Villoslada C. et al. Anorectal function in patients with complete rectal prolapse. Differences between continent and incontinent individuals. Rev. Esp. Enferm. Dig. 1998; 90(11): 794-805.
  5. Lubowski D.Z., Swash M., Nicholls R.J., Henry M.M. Increase in pudendal nerve terminal motor latency with defaecation straining. Br. J. Surg. 1988; 75(11): 1095-7. https://dx.doi.org/10.1002/bjs.1800751115.
  6. Laurberg S., Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis. Colon Rectum. 1989; 32(9): 737-42. https://dx.doi. org/10.1007/bf02562120.
  7. Bakas P., Liapis A., Karandreas A., Creatsas G. Pudendal nerve terminal motor latency in women with genuine stress incontinence and prolapse. Gynecol. Obstet. Invest. 2001; 51(3): 187-90. https://dx.doi.org/10.1159/000052922.
  8. Kiff E.S., Barnes PR, Swash M. Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool. Gut. 1984; 25(11): 1279-82.
  9. Beevors M.A., Lubowski D.Z., King D.W., Carlton M.A. Pudendal nerve function in women with symptomatic utero-vaginal prolapse. Int. J. Colorectal Dis. 1991; 6(1): 24-8. https://dx.doi.org/10.1007/bf00703956.
  10. Boyle D.J., Knowles C.H., Murphy J., Bhan C., Williams N.S., Scott S.M., Lunniss PJ. The effects of age and childbirth on anal sphincter function and morphology in 999 symptomatic female patients with colorectal dysfunction. Dis. Colon Rectum. 2012; 55(3): 286-93. https://dx.doi.org/10.1097/ DCR.0b013e31823fe7f1.
  11. Snooks S.J., Nicholls R.J., Henry M.M., Swash M. Electrophysiological and manometric assessment of the pelvic floor in the solitary rectal ulcer syndrome. Br. J. Surg. 1985; 72(2): 131-3. https://dx.doi.org/10.1002/bjs.1800720221.
  12. Tetzschner T., Sorensen M., Rasmussen O.O., Lose G., Christiansen J. Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth. Acta Obstet. Gynecol. Scand. 1995; 74(6): 434-40. https://dx.doi.org/10.3109/00016349509024405.
  13. Ryhammer A.M., Laurberg S., Hermann A.P. No correlation between perineal position and pudendal nerve terminal motor latency in healthy perimenopausal women. Dis. Colon Rectum. 1998; 41(3): 350-3. https://dx.doi.org/10.1007/ bf02237490.
  14. Jorge J.M., Wexner S.D., Ehrenpreis E.D., Nogueras J.J., Jagelman D.G. Does perineal descent correlate with pudendal neuropathy? Dis. Colon Rectum. 1993; 36(5): 475-83. https://dx.doi.org/10.1007/ bf02050014.
  15. Cooper E.A., De-Loyde K.J., Young C.J., Shepherd H.L., Wright C. Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence. Int. J. Colorectal Dis. 2016; 31(8): 1437-42. https://dx.doi.org/10.1007/s00384-016-2617-3.
  16. Cannon J.A. Evaluation, diagnosis, and medical management of rectal prolapse. Clin. Colon Rectal Surg. 2017; 30(1): 16-21. https://dx.doi. org/10.1055/s-0036-1593431.
  17. Jorge J.M., Wexner S.D. Etiology and management of fecal incontinence. Dis. Colon Rectum. 1993; 36(1): 77-97. https://dx.doi.org/10.1007/bf02050307.
  18. Шелыгин Ю.А., ред. Клинические рекомендации. Колопроктология. 2-е изд. М.: ГЭОТАР-Медиа; 2017.
  19. Olsen A.L., Ross M., Stansfield R.B., Kreiter C. Pelvic floor nerve conduction studies: establishing clinically relevant normative data. Am. J. Obstet. Gynecol. 2003; 189(4): 1114-9. https://dx.doi.org/10.1067/s0002-9378(03)00551-9.
  20. Шелыгин Ю.А., Фоменко О.Ю., Веселов В.В., Белоусова С.В., Алешин Д.В., Вязьмин Д.О. Нормативные показатели давления в анальном канале при неперфузионной манометрии. Колопроктология. 2015; 3: 4-9.
  21. Шелыгин Ю.А., Фоменко О.Ю., Титов А.Ю., Берсенева Е.А., Мудров А.А., Белоусова С.В. Сфинктерометрическая градация недостаточности анального сфинктера. Колопроктология. 2016; 4: 54-9.
  22. Шелыгин Ю.А., Фоменко О.Ю., Титов А.Ю., Веселов В.В., Белоусова С.В., Алешин Д.В. Сфинктерометрические показатели в анальном канале в норме. Колопроктология. 2016; 2: 32-6.
  23. Шелыгин Ю.А., Фоменко О.Ю., Титов А.Ю., Веселов В.В., Белоусова С.В., Мудров А.А. Нормативные показатели давления в анальном канале при сфинктерометрии на приборах S. 4402 МSМ и WPM Solar GI. Экспериментальная и клиническая гастроэнтерология. 2016; 8: 46-50.
  24. Шелыгин Ю.А., Попов А.А., Фоменко О.Ю., Мудров А.А., Козлов В.А., Федоров А.А., Белоусова С.В., Ефремова Е.С. Нарушение функции держания у пациенток с пролапсом гениталий. Российский вестник акушера-гинеколога. 2018; 18(6): 62-6.
  25. Фоменко О.Ю., Шелыгин Ю.А., Попов А.А., Порядин Г.В., Титов А.Ю., Берсенева Е.А., Мудров А.А., Белоусова С.В. Функциональное состояние мышц тазового дна у больных ректоцеле. Российский вестник акушера-гинеколога. 2017; 17(3): 43-8.
  26. Алиев Э.А., Ахмедова Э.В. Пролапс тазовых органов. Колопроктология. 2016; 2: 42-7.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies