ELECTRODIAGNOSTIC EVALUATION OF FECAL INCONTINENCE

The aim of this study was to assess the utility of electrodiagnostic t esting (EDT) for the evaluation of fecal incontinence (FI). Over a 5-y ear period, 225 patients (174 females) with FI were prospectively stud ied with anal manometry, anal ultrasonography, anal electromyography ( AEMG), and pudendal nerve terminal motor latency (PNTML) assessment. T he mean age was 60 (range 12-94) years. Causes of FI identified by cli nical evaluation were obstetric injuries (45), rectal prolapse (43), i atrogenic or other trauma (42), neurologic disease (23), and idiopathi c (72). EDT revealed abnormalities in 76% of patients. The incidence o f pudendal neuropathy (PN) was 36% (bilateral 21%, unilateral 15%). Pa tients with PN were older than were those with normal PNTML (mean 71 v s. 63 years; P < 0.002). No relationship between squeeze pressure and PN could be demonstrated (P = 0.9). Reduced motor unit potential (MUP) recruitment on AEMG was present in 60% and was associated with decrea sed squeeze pressure (P < 0.001) and increased MUP polyphasia (P < 0.0 01). Concurrence of AEMG and anal ultrasonographic findings was observ ed in 35 of 41 patients (84%). Defects were overlooked in one study bu t identified by the other on three occasions, each. Moreover, 8 of 22 patients with demonstrated sphincter defects had unsuspected PN or ext ensive sphincter injury on AEMG that precluded sphincter repair. In co nclusion, EDT proved to be a valuable tool in the evaluation and subse quent treatment of patients with FI. (C) 1995 John Wiley and Sons, Inc .