Advertisement

Neurogenic Fecal Incontinence

  • Giuseppe Pelliccioni
  • Osvaldo Scarpino

Abstract

Fecal incontinence, according to the most used definition, is the “involuntary loss of the stool or soiling at a socially inappropriate time or place” [1]. It is an important health issue that strongly affects patient quality of life and restricts their social activities. It is a common problem, with prevalence ranging from 2.2% to 15% in the community and up to 40% in nursing homes [2]. The prevalence of fecal incontinence in neurological patients is higher than in the general population. Many neurological disorders are associated with fecal incontinence, and this chapter is a review of the current clinical knowledge regarding the pathogenesis and clinical findings. When considering the possible effects of central and peripheral neurological lesions on fecal continence, it is important to keep in mind that continence depends on intact neural pathways and normal function of the cerebral, spinal, and cauda equina centers, and peripheral nerves. It should be remembered, however, that signs, symptoms, and gastrointestinal dysfunction may differ from expectations by virtue of incomplete neuronal lesions, coexisting involvement of supraspinal or spinal centers, or damage to the distal parts of the autonomic or somatic innervation of the pelvic floor sphincter muscles.

Keywords

Spinal Cord Injury Pelvic Floor Transcranial Magnetic Stimulation Multiple Sclerosis Patient Anal Sphincter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lamah M, Kumar D (1999) Fecal incontinence. Dig Dis Sci 44:2488–2499PubMedCrossRefGoogle Scholar
  2. 2.
    Nelson RL (2004) Epidemiology of fecal incontinence. Gastroenterology 126:S3–S7PubMedCrossRefGoogle Scholar
  3. 3.
    Rao SS (2004) Pathophysiology of adult fecal incontinence. Gastroenterology 126:S14–S22PubMedCrossRefGoogle Scholar
  4. 4.
    Andrew J, Nathan PW (1964) Lesions on the anterior frontal lobes and disturbances of micturition and defaecation. Brain 87:233–262PubMedCrossRefGoogle Scholar
  5. 5.
    Kaddumi EG, Hubscher CH (2006) Convergence of multiple pelvic organ inputs in the rat rostral medulla. J Physiol 572:393–405PubMedCrossRefGoogle Scholar
  6. 6.
    Bouvier M, Grimaud JC (1984) Neuronally mediated interactions between urinary bladder and internal anal sphincter motility in the cat. J Physiol 346:461–469PubMedGoogle Scholar
  7. 7.
    Bouvier M, Grimaud JC, Abysique A (1990) Effects of stimulation of vesical afferents on colonic motility in cats. Gastroenterology 98:1148–1154PubMedGoogle Scholar
  8. 8.
    Duthie HL, Gairns FW (1960) Sensory nerve-endings and sensation in the anal region of man. Br J Surg 47:585–595PubMedCrossRefGoogle Scholar
  9. 9.
    Rogers J (1992) Testing for and the role of anal and rectal sensation. Baillieres Clin Gastroenterol 6:179–191PubMedCrossRefGoogle Scholar
  10. 10.
    Lynn PA, Olsson C, Zagorodnyuk V et al (2003) Rectal intraganglionic laminar endings are transduction sites of extrinsic mechanoreceptors in the guinea pig rectum. Gastroenterology 125:786–794PubMedCrossRefGoogle Scholar
  11. 11.
    Frenckner B, Euler CV (1975) Influence of pudendal block on the function of the anal sphincters. Gut 16:482–489PubMedCrossRefGoogle Scholar
  12. 12.
    Hobday DI, Aziz Q, Thacker N et al (2001) A study of the cortical processing of ano-rectal sensation using functional MRI. Brain 124:361–368PubMedCrossRefGoogle Scholar
  13. 13.
    Grundy D, Al-Chaer ED, Aziz Q et al (2006) Fundamentals of neurogastroenterology: basic science. Gastroenterology 130:1391–1411PubMedCrossRefGoogle Scholar
  14. 14.
    Norton C (1996) Faecal incontinence in adults. 1: Prevalence and causes. Br J Nurs 5:1366–1368, 1370–1374PubMedGoogle Scholar
  15. 15.
    Kamm MA (1998) Faecal incontinence. BMJ 316:528–532PubMedGoogle Scholar
  16. 16.
    Harari D, Coshall C, Rudd AG, Wolfe CD (2003) Newonset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke 34:144–150PubMedCrossRefGoogle Scholar
  17. 17.
    Baztan JJ, Domenech JR, Gonzalez M (2003) Newonset fecal incontinence after stroke: risk factor or consequence of poor outcomes after rehabilitation? Stroke 34:e101–102PubMedCrossRefGoogle Scholar
  18. 18.
    Nakayama H, Jorgensen HS, Pedersen PM et al (1997) Prevalence and risk factors of incontinence after stroke. The Copenhagen Stroke Study. Stroke 28:58–62PubMedGoogle Scholar
  19. 19.
    Scandinavian Stroke Study Group (1985) Multicenter trial of hemodilution in ischemie stroke-background and study protocol. Stroke 16:885–890Google Scholar
  20. 20.
    Wade DT, Hewer RL (1985) Outlook after an acute stroke: urinary incontinence and loss of consciousness compared in 532 patients. Q J Med 56:601–608PubMedGoogle Scholar
  21. 21.
    Ween JE, Alexander MP, D’Esposito M, Roberts M (1996) Incontinence after stroke in a rehabilitation setting: outcome associations and predictive factors. Neurology 47:659–663PubMedGoogle Scholar
  22. 22.
    Patel M, Coshall C, Rudd AG, Wolfe CD (2001) Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke 32:122–127PubMedGoogle Scholar
  23. 23.
    Taub NA, Wolfe CD, Richardson E, Burney PG (1994) Predicting the disability of first-time stroke sufferers at 1 year. 12-month follow-up of a population-based cohort in southeast England. Stroke 25:352–357PubMedGoogle Scholar
  24. 24.
    Gelber DA, Good DC, Laven LJ, Verhulst SJ (1993) Causes of urinary incontinence after acute hemispheric stroke. Stroke 24:378–382PubMedGoogle Scholar
  25. 25.
    Robain G, Chennevelle JM, Petit F, Piera JB (2002) [Incidence of constipation after recent vascular hemiplegia: a prospective cohort of 152 patients]. Rev Neurol 158:589–592PubMedGoogle Scholar
  26. 26.
    Stocchi F, Badiali D, Vacca L et al (2000) Anorectal function in multiple system atrophy and Parkinson’s disease. Mov Disord 15:71–76PubMedCrossRefGoogle Scholar
  27. 27.
    Sakakibara R, Shinotoh H, Uchiyama T et al (2001) Questionnaire-based assessment of pelvic organ dysfunction in Parkinson’s disease. Auton Neurosci 92:76–85PubMedCrossRefGoogle Scholar
  28. 28.
    Edwards LL, Quigley EM, Harned RK et al (1994) Characterization of swallowing and defecation in Parkinson’s disease. Am J Gastroenterol 89:15–25PubMedGoogle Scholar
  29. 29.
    Mathers SE, Kempster PA, Swash M, Lees AJ (1988) Constipation and paradoxical puborectalis contraction in anismus and Parkinson’s disease: a dystonic phenomenon? J Neurol Neurosurg Psychiatry 51:1503–1507PubMedGoogle Scholar
  30. 30.
    Edwards LL, Quigley EM, Harned RK et al (1993) Defecatory function in Parkinson’s disease: response to apomorphine. Ann Neurol 33:490–493PubMedCrossRefGoogle Scholar
  31. 31.
    Edwards LL, Quigley EM, Pfeiffer RF (1992) Gastrointestinal dysfunction in Parkinson’s disease: frequency and pathophysiology. Neurology 42:726–732PubMedGoogle Scholar
  32. 32.
    Singaram C, Ashraf W, Gaumnitz EA et al (1995) Dopaminergic defect of enteric nervous system in Parkinson’s disease patients with chronic constipation. Lancet 346:861–864PubMedCrossRefGoogle Scholar
  33. 33.
    Bauer HJ, Firnhaber W, Winkler W (1965) Prognostic Criteria In Multiple Sclerosis. Ann N Y Acad Sci 122:542–551PubMedCrossRefGoogle Scholar
  34. 34.
    Crayton H, Heyman RA, Rossman HS (2004) A multimodal approach to managing the symptoms of multiple sclerosis. Neurology 63:S12–18PubMedGoogle Scholar
  35. 35.
    Miller H, Simpson CA, Yeates WK (1965) Bladder Dysfunction In Multiple Sclerosis. Br Med J 5445:1265–1269Google Scholar
  36. 36.
    Andersen JT, Bradley WE (1976) Abnormalities of detrusor and sphincter function in multiple sclerosis. Br J Urol 48:193–198PubMedGoogle Scholar
  37. 37.
    Blaivas JG, Bhimani G, Labib KB (1979) Vesicourethral dysfunction in multiple sclerosis. J Urol 122:342–347PubMedGoogle Scholar
  38. 38.
    Bennett N, O’Leary M, Patel AS et al (2004) Can higher doses of oxybutynin improve efficacy in neurogenic bladder? J Urol 171:749–751PubMedCrossRefGoogle Scholar
  39. 39.
    Chia YW, Fowler CJ, Kamm MA et al (1995) Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J Neurol 242:105–108PubMedCrossRefGoogle Scholar
  40. 40.
    Bakke A, Myhr KM, Gronning M, Nyland H (1996) Bladder, bowel and sexual dysfunction in patients with multiple sclerosis-a cohort study. Scand J Urol Nephrol Suppl 179:61–66PubMedGoogle Scholar
  41. 41.
    Rosenblum D, Saffir M (1998) The natural history of multiple sclerosis and its diagnosis. Phys Med Rehabil Clin N Am 9:537–549PubMedGoogle Scholar
  42. 42.
    Hinds JP, Eidelman BH, Wald A (1990) Prevalence of bowel dysfunction in multiple sclerosis. A population survey. Gastroenterology 98:1538–1542PubMedGoogle Scholar
  43. 43.
    Swash M, Snooks SJ, Chalmers DH (1987) Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 44:504–508PubMedGoogle Scholar
  44. 44.
    Glick ME, Meshkinpour H, Haldeman S et al (1982) Colonic dysfunction in multiple sclerosis. Gastroenterology 83:1002–1007PubMedGoogle Scholar
  45. 45.
    Waldron DJ, Horgan PG, Patel FR et al (1993) Multiple sclerosis: assessment of colonic and anorectal function in the presence of faecal incontinence. Int J Colorectal Dis 8:220–224PubMedCrossRefGoogle Scholar
  46. 46.
    Sorensen M, Lorentzen M, Petersen J, Christiansen J (1991) Anorectal dysfunction in patients with urologie disturbance due to multiple sclerosis. Dis Colon Rectum 34:136–139PubMedCrossRefGoogle Scholar
  47. 47.
    Jameson JS, Rogers J, Chia YW et al (1994) Pelvic floor function in multiple sclerosis. Gut 35:388–390PubMedCrossRefGoogle Scholar
  48. 48.
    Nordenbo AM, Andersen JR, Andersen JT (1996) Disturbances of ano-rectal function in multiple sclerosis. J Neurol 243:445–451PubMedCrossRefGoogle Scholar
  49. 49.
    Weber J, Grise P, Roquebert M et al (1987) Radiopaque markers transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction. Dis Colon Rectum 30:95–100PubMedCrossRefGoogle Scholar
  50. 50.
    Haldeman S, Glick M, Bhatia NN et al (1982) Colonometry, cystometry, and evoked potentials in multiple sclerosis. Arch Neurol 39:698–701PubMedGoogle Scholar
  51. 51.
    Glickman S, Kamm MA (1996) Bowel dysfunction in spinal-cord-injury patients. Lancet 347:1651–1653PubMedCrossRefGoogle Scholar
  52. 52.
    Krogh K, Mosdal C, Laurberg S (2000) Gastrointestinal and segmentai colonic transit times in patients with acute and chronic spinal cord lesions. Spinal Cord 38:615–621PubMedCrossRefGoogle Scholar
  53. 53.
    Krogh K, Nielsen J, Djurhuus JC et al (1997) Colorectal function in patients with spinal cord lesions. Dis Colon Rectum 40:1233–1239PubMedCrossRefGoogle Scholar
  54. 54.
    Lynch AC, Anthony A, Dobbs BR, Frizelle FA (2000) Anorectal physiology following spinal cord injury. Spinal Cord 38:573–580PubMedCrossRefGoogle Scholar
  55. 55.
    Lynch AC, Antony A, Dobbs BR, Frizelle FA (2001) Bowel dysfunction following spinal cord injury. Spinal Cord 39:193–203PubMedCrossRefGoogle Scholar
  56. 56.
    Lynch AC, Wong C, Anthony A et al (2000) Bowel dysfunction following spinal cord injury: a description of bowel function in a spinal cord-injured population and comparison with age and gender matched controls. Spinal Cord 38:717–723PubMedCrossRefGoogle Scholar
  57. 57.
    Stone JM, Nino-Murcia M, Wolfe VA, Perkash I (1990) Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Am J Gastroenterol 85:1114–1119PubMedGoogle Scholar
  58. 58.
    Randell N, Lynch AC, Anthony A et al (2001) Does a colostomy alter quality of life in patients with spinal cord injury? A controlled study. Spinal Cord 39:279–282PubMedCrossRefGoogle Scholar
  59. 59.
    Stone JM, Wolfe VA, Nino-Murcia M, Perkash I (1990) Colostomy as treatment for complications of spinal cord injury. Arch Phys Med Rehabil 71:514–518PubMedGoogle Scholar
  60. 60.
    Kelly SR, Shashidharan M, Borwell B et al (1999) The role of intestinal stoma in patients with spinal cord injury. Spinal Cord 37:211–214PubMedCrossRefGoogle Scholar
  61. 61.
    Krogh K, Mosdal C, Gregersen H, Laurberg S (2002) Rectal wall properties in patients with acute and chronic spinal cord lesions. Dis Colon Rectum 45:641–649PubMedCrossRefGoogle Scholar
  62. 62.
    Kirk PM, King RB, Temple R et al (1997) Long-term follow-up of bowel management after spinal cord injury. SCI Nurs 14:56–63PubMedGoogle Scholar
  63. 63.
    Stiens SA, Bergman SB, Goetz LL (1997) Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management. Arch Phys Med Rehabil 78:S86–102PubMedCrossRefGoogle Scholar
  64. 64.
    Yim SY, Yoon SH, Lee IY et al (2001) A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel. Spinal Cord 39:204–207PubMedCrossRefGoogle Scholar
  65. 65.
    Benevento BT, Sipski ML (2002) Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther 82:601–612PubMedGoogle Scholar
  66. 66.
    Bartolo DC, Jarratt JA, Read NW (1983) The use of conventional electromyography to assess external sphincter neuropathy in man. J Neurol Neurosurg Psychiatry 46:1115–1118PubMedGoogle Scholar
  67. 67.
    Staas WE Jr, Nemunaitis G (1989) Management of reflex sweating in spinal cord injured patients. Arch Phys Med Rehabil 70:544–546PubMedGoogle Scholar
  68. 68.
    DeLooze D, VanLaere M, DeMuynck M et al (1998) Constipation and other chronic gastrointestinal problems in spinal cord injury patients. Spinal Cord 36:63–66PubMedCrossRefGoogle Scholar
  69. 69.
    Rajendran SK, Reiser JR, Bauman W et al (1992) Gastrointestinal transit after spinal cord injury: effect of cisapride. Am J Gastroenterol 87:1614–1617PubMedGoogle Scholar
  70. 70.
    Keshavarzian A, Barnes WE, Bruninga K et al (1995) Delayed colonic transit in spinal cord-injured patients measured by indium-Ill Amberlite scintigraphy. Am J Gastroenterol 90:1295–1300PubMedGoogle Scholar
  71. 71.
    Glick ME, Meshkinpour H, Haldeman S et al (1984) Colonie dysfunction in patients with thoracic spinal cord injury. Gastroenterology 86:287–294PubMedGoogle Scholar
  72. 72.
    Lie HR, Lagergren J, Rasmussen F et al (1991) Bowel and bladder control of children with myelomeningocele: a Nordic study. Dev Med Child Neurol 33:1053–1061PubMedCrossRefGoogle Scholar
  73. 73.
    Malone PS, Wheeler RA, Williams JE (1994) Continence in patients with spina bifida: long term results. Arch Dis Child 70:107–110PubMedGoogle Scholar
  74. 74.
    Rintala RJ (2002) Fecal incontinence in anorectal malformations, neuropathy, and miscellaneous conditions. Semin Pediatr Surg 11:75–82PubMedCrossRefGoogle Scholar
  75. 75.
    Agnarsson U, Warde C, McCarthy G et al (1993) Anorectal function of children with neurological problems. I: Spina bifida. Dev Med Child Neurol 35:893–902PubMedCrossRefGoogle Scholar
  76. 76.
    Arhan P, Faverdin C, Devroede G et al (1984) Anorectal motility after surgery for spina bifida. Dis Colon Rectum 27:159–163PubMedCrossRefGoogle Scholar
  77. 77.
    Levitt MA, Patel M, Rodriguez G et al (1997) The tethered spinal cord in patients with anorectal malformations. J Pediatr Surg 32:462–468PubMedCrossRefGoogle Scholar
  78. 78.
    Shapiro S (1993) Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 32:743–746; discussion 746–747PubMedCrossRefGoogle Scholar
  79. 79.
    Gleave JR, MacFarlane R (1990) Prognosis for recovery of bladder function following lumbar central disc prolapse. Br J Neurosurg 4:205–209PubMedGoogle Scholar
  80. 80.
    Wald A, Tunuguntla AK (1984) Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 310:1282–1287PubMedCrossRefGoogle Scholar
  81. 81.
    Kyle RA (1995) Monoclonal gammopathy of undetermined significance (MGUS). Baillieres Clin Haematol 8:761–781PubMedCrossRefGoogle Scholar
  82. 82.
    Zochodne DW, Ramsay DA, Saly V et al (1994) Acute necrotizing myopathy of intensive care: electrophysiological studies. Muscle Nerve 17:285–292PubMedCrossRefGoogle Scholar
  83. 83.
    Healton EB, Savage DG, Brust JC et al (1991) Neurologic aspects of cobalamin deficiency. Medicine 70:229–245PubMedCrossRefGoogle Scholar
  84. 84.
    Nowak TV, Anuras S, Brown BP et al (1984) Small intestinal motility in myotonic dystrophy patients. Gastroenterology 86:808–813PubMedGoogle Scholar
  85. 85.
    Nowak TV, Ionasescu V, Anuras S (1982) Gastrointestinal manifestations of the muscular dystrophies. Gastroenterology 82:800–810PubMedGoogle Scholar
  86. 86.
    Yoshida MM, Krishnamurthy S, Wattchow DA et al (1988) Megacolon in myotonic dystrophy caused by a degenerative neuropathy of the myenteric plexus. Gastroenterology 95:820–827PubMedGoogle Scholar
  87. 87.
    Harper PS (1979) Myotonic dystrophy, major problems in neurology, Vol. 9. Saunders, Philadelphia, pp 1–324Google Scholar
  88. 88.
    Brunner HG, Hamel BC, Rieu P et al (1992) Intestinal pseudo-obstruction in myotonic dystrophy. J Med Genet 29:791–793PubMedGoogle Scholar
  89. 89.
    Eckardt VF, Nix W (1991) The anal sphincter in patients with myotonic muscular dystrophy. Gastroenterology 100:424–430PubMedGoogle Scholar
  90. 90.
    Chaudhry V, Umapathi T, Ravich WJ (2002) Neuromuscular diseases and disorders of the alimentary system. Muscle Nerve 25:768–784PubMedCrossRefGoogle Scholar
  91. 91.
    Abercrombie JF, Rogers J, Swash M (1998) Faecal incontinence in myotonic dystrophy. J Neurol Neurosurg Psychiatry 64:128–130PubMedGoogle Scholar
  92. 92.
    Perkin GD, Murray-Lyon I (1998) Neurology and the gastrointestinal system. J Neurol Neurosurg Psychiatry 65:291–300PubMedCrossRefGoogle Scholar
  93. 93.
    Leon SH, Schuffler MD, Kettler M, Rohrmann CA (1986) Chronic intestinal pseudoobstruction as a complication of Duchenne’s muscular dystrophy. Gastroenterology 90:455–459PubMedGoogle Scholar
  94. 94.
    Bensen ES, Jaffe KM, Tarr PI (1996) Acute gastric dilatation in Duchenne muscular dystrophy: a case report and review of the literature. Arch Phys Med Rehabil 77:512–514PubMedCrossRefGoogle Scholar
  95. 95.
    Khan OA, Campbell WW (1994) Myasthenia gravis presenting as dysphagia: clinical considerations. Am J Gastroenterol 89:1083–1085PubMedGoogle Scholar
  96. 96.
    Kluin KJ, Bromberg MB, Feldman EL, Simmons Z (1996) Dysphagia in elderly men with myasthenia gravis. J Neurol Sci 138:49–52PubMedCrossRefGoogle Scholar
  97. 97.
    Berger AR, Swerdlow M, Herskovitz S (1996) Myasthenia gravis presenting as uncontrollable flatus and urinary/fecal incontinence. Muscle Nerve 19:113–114PubMedGoogle Scholar
  98. 98.
    Podnar S (2003) Electrodiagnosis of the anorectum: a review of techniques and clinical applications. Tech Coloproctol 7:71–76PubMedCrossRefGoogle Scholar
  99. 99.
    Sultan AH, Kamm MA, Hudson CN et al (1993) Analsphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMedCrossRefGoogle Scholar
  100. 100.
    Enck P, vonGiesen HJ, Schafer A et al (1996) Comparison of anal sonography with conventional needle electromyography in the evaluation of anal sphincter defects. Am J Gastroenterol 91:2539–2543PubMedGoogle Scholar
  101. 101.
    Stoker J, Bartram CI, Halligan S (2002) Imaging of the posterior pelvic floor. Eur Radiol 12:779–788PubMedCrossRefGoogle Scholar
  102. 102.
    Hussain SM, Stoker J, Schutte HE, Lameris JS (1996) Imaging of the anorectal region. Eur J Radiol 22:116–122PubMedCrossRefGoogle Scholar
  103. 103.
    Rao SS (1997) Manometric evaluation of defecation disorders: Part II. Fecal incontinence. Gastroenterologist 5:99–111PubMedGoogle Scholar
  104. 104.
    Podnar S, Vodusek DB (2001) Protocol for clinical neurophysiologic examination of the pelvic floor. Neurourol Urodyn 20:669–682PubMedCrossRefGoogle Scholar
  105. 105.
    Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80PubMedCrossRefGoogle Scholar
  106. 106.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRefGoogle Scholar
  107. 107.
    Fowler CJ (2001) A neurologist’s clinical and investigative approach to patients with bladder, bowel and sexual dysfunction. In: Fowler CJ (ed) Neurology of bladder, bowel, and sexual dysfunction. Elsevier, Boston, pp 1–6Google Scholar
  108. 108.
    Pedersen E, Klemar B, Schroder HD, Torring J (1982) Anal sphincter responses after perianal electrical stimulation. J Neurol Neurosurg Psychiatry 45:770–773PubMedGoogle Scholar
  109. 109.
    Swash M (1982) Early and late components in the human anal reflex. J Neurol Neurosurg Psychiatry 45:767–769PubMedCrossRefGoogle Scholar
  110. 110.
    Vodusek DB, Janko M, Lokar J (1983) Direct and reflex responses in perineal muscles on electrical stimulation. J Neurol Neurosurg Psychiatry 46:67–71PubMedGoogle Scholar
  111. 111.
    Podnar S (2004) Criteria for neuropathic abnormality in quantitative anal sphincter electromyography. Muscle Nerve 30:596–601PubMedCrossRefGoogle Scholar
  112. 112.
    Podnar S, Fowler CJ (2004) Sphincter electromyography in diagnosis of multiple system atrophy: technical issues. Muscle Nerve 29:151–156PubMedCrossRefGoogle Scholar
  113. 113.
    Podnar S, Mrkaic M (2002) Predictive power of motor unit potential parameters in anal sphincter electromyography. Muscle Nerve 26:389–394PubMedCrossRefGoogle Scholar
  114. 114.
    Podnar S, Vodusek DB, Stalberg E (2002) Comparison of quantitative techniques in anal sphincter electromyography. Muscle Nerve 25:83–92PubMedCrossRefGoogle Scholar
  115. 115.
    Floyd WF, Walls EW (1953) Electromyography of the sphincter ani extern us in man. J Physiol 122:599–609PubMedGoogle Scholar
  116. 116.
    Swash M (1992) Electromyography in pelvic floor disorders. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworth Heinemann, Oxford, pp 184–195Google Scholar
  117. 117.
    Stryker SJ, Daube JR, Kelly KA et al (1985) Anal sphincter electromyography after colectomy, mucosal rectectomy, and ileoanal anastomosis. Arch Surg 120:713–716PubMedGoogle Scholar
  118. 118.
    Cheong DM, Vaccaro CA, Salanga VD et al (1995) Electrodiagnostic evaluation of fecal incontinence. Muscle Nerve 18:612–619PubMedCrossRefGoogle Scholar
  119. 119.
    Fowler CJ, Benson JT, Craggs MD et al (2002) Clinical neurophysiology. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. 2nd International Consultation on Incontinence. Plymbridge Distributors, Plymouth, pp 389–424Google Scholar
  120. 120.
    Ertekin C, Reel F (1976) Bulbocavernosus reflex in normal men and in patients with neurogenic bladder and/or impotence. J Neurol Sci 28:1–15PubMedCrossRefGoogle Scholar
  121. 121.
    Fowler CJ (1995) Pelvic floor neurophysiology. In: Clinical neurophysiology. Butterworth Heinemann, Oxford, pp 233–252Google Scholar
  122. 122.
    Loening-Baucke V, Anderson RH, Yamada T, Zhu YX (1995) Study of the afferent pathways from the rectum with a new distention control device. Neurology 45:1510–1516PubMedGoogle Scholar
  123. 123.
    Frieling T, Enck P, Wienbeck M (1989) Cerebral responses evoked by electrical stimulation of rectosigmoid in normal subjects. Dig Dis Sci 34:202–205PubMedCrossRefGoogle Scholar
  124. 124.
    Loening-Baucke V, Read NW, Yamada T (1992) Further evaluation of the afferent nervous pathways from the rectum. Am J Physiol 262:G927–933PubMedGoogle Scholar
  125. 125.
    Meunier P, Collet L, Duclaux R, Chery-Croze S (1987) Endorectal cerebral evoked potentials in human. Int J Neurosci 37:193–196PubMedGoogle Scholar
  126. 126.
    Delechenault P, Leroi AM, Bruna T et al (1993) Cerebral potentials evoked by electrical stimulation of the anal canal. Dis Colon Rectum 36:55–60PubMedCrossRefGoogle Scholar
  127. 127.
    Barker AT, Jalinous R, Freeston IL (1985) Non-invasive magnetic stimulation of human motor cortex. Lancet 1:1106–1107PubMedCrossRefGoogle Scholar
  128. 128.
    Rothwell JC, Hallett M, Berardelli A et al (1999) Magnetic stimulation: motor evoked potentials. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl 52:97–103PubMedGoogle Scholar
  129. 129.
    Opsomer RJ, Caramia MD, Zarola F et al (1989) Neurophysiological evaluation of central-peripheral sensory and motor pudendal fibres. Electroencephalogr Clin Neurophysiol 74:260–270PubMedCrossRefGoogle Scholar
  130. 130.
    Ertekin C, Hansen MV, Larsson LE, Sjodahl R (1990) Examination of the descending pathway to the external anal sphincter and pelvic floor muscles by transcranial cortical stimulation. Electroencephalogr Clin Neurophysiol 75:500–510PubMedCrossRefGoogle Scholar
  131. 131.
    Pelliccioni G, Scarpino O, Piloni V (1997) Motor evoked potentials recorded from external anal sphincter by cortical and lumbo-sacral magnetic stimulation: normative data. J Neurol Sci 149:69–72PubMedCrossRefGoogle Scholar
  132. 132.
    King PJL, Chiappa KH (1989) Motor evoked potentials. In: Chiappa KH (ed) Evoked potentials in clinical medicine. Raven Press, New York, pp 509–561Google Scholar
  133. 133.
    Mathers SE, Ingram DA, Swash M (1990) Electrophysiology of motor pathways for sphincter control in multiple sclerosis. J Neurol Neurosurg Psychiatry 53:955–960PubMedGoogle Scholar
  134. 134.
    DelCarro U, Riva D, Comi GC et al (1993) Neurophysiological evaluation in detrusor instability. Neurourol Urodyn 12:455–462PubMedCrossRefGoogle Scholar
  135. 135.
    Gunnarsson M, Ahlmann S, Lindstrom S et al (1999) Cortical magnetic stimulation in patients with genuine stress incontinence: correlation with results of pelvic floor exercises. Neurourol Urodyn 18:437–444; discussion 444–435PubMedCrossRefGoogle Scholar
  136. 136.
    Brostrom S, Frederiksen JL, Jennum P, Lose G (2003) Motor evoked potentials from the pelvic floor in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 74:498–500PubMedCrossRefGoogle Scholar
  137. 137.
    Jennum P, Neerup Jensen L, Fenger K et al (2001) Motor evoked potentials from the external anal sphincter in patients with autosomal dominant pure spastic paraplegia linked to chromosome 2p. J Neurol Neurosurg Psychiatry 71:561–562PubMedCrossRefGoogle Scholar
  138. 138.
    Kiff ES, Swash M (1984) Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71:614–616PubMedCrossRefGoogle Scholar
  139. 139.
    Kiff ES, Swash M (1984) Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. J Neurol Neurosurg Psychiatry 47:820–823PubMedCrossRefGoogle Scholar
  140. 140.
    Snooks SJ, Badenoch DF, Tiptaft RC, Swash M (1985) Perineal nerve damage in genuine stress urinary incontinence. An electrophysiological study. Br J Urol 57:422–426PubMedCrossRefGoogle Scholar
  141. 141.
    Snooks SJ, Setchell M, Swash M, Henry MM (1984) Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 2:546–550PubMedCrossRefGoogle Scholar
  142. 142.
    Jones PN, Lubowski DZ, Swash M, Henry MM (1987) Relation between perineal descent and pudendal nerve damage in idiopathic faecal incontinence. Int J Colorectal Dis 2:93–95PubMedCrossRefGoogle Scholar
  143. 143.
    Smith AR, Hosker GL, Warrell DW (1989) The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol 96:29–32PubMedGoogle Scholar
  144. 144.
    Smith AR, Hosker GL, Warrell DW (1989) The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol 96:24–28PubMedGoogle Scholar
  145. 145.
    Gilliland R, Altomare DF, Moreira H Jr et al (1998) Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum 41:1516–1522PubMedCrossRefGoogle Scholar
  146. 146.
    Bakas P, Liapis A, Karandreas A, Creatsas G (2001) Pudendal nerve terminal motor latency in women with genuine stress incontinence and prolapse. Gynecol Obstet Invest 51:187–190PubMedCrossRefGoogle Scholar
  147. 147.
    Barnett JL, Hasler WL, Camilleri M (1999) American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association. Gastroenterology 116:732–760PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Giuseppe Pelliccioni
  • Osvaldo Scarpino

There are no affiliations available

Personalised recommendations