PREVALENCE OF PUDENDAL NEUROPATHY IN FECAL INCONTINENCE - RESULTS OF A PROSPECTIVE-STUDY

PURPOSE: A prospective study was made of the prevalence and associatio ns of pudendal neuropathy in 96 patients with fecal incontinence (72 f emales and 24 males). METHODS: Clinical exploration, perineal level me asurement: anorectal manometry, and electrophysiologic evaluations (pu dendal nerve terminal motor latency (PNTML) and external sphincter fib er density (FD)) were performed. RESULTS: Pudendal neuropathy (defined as PNTML > 2.2 ms or FD > 1.65) was found in 67 patients (69.8 percen t) and was more common in females (75 percent) than in males (50 perce nt; P = 0.05). Pudendal neuropathy was also more frequent in patients with pathologic perineal descent (85 percent vs. 55 percent; P < 0.01) or exhibiting risk factors such as difficult labor or excessive defec atory straining (P < 0.01). Perineal level at straining correlated inv ersely with both PNTML and FD (P < 0.01). Manometric findings suggeste d greater external anal sphincter damage in patients with pudendal neu ropathy than in those suffering fecal incontinence but no neuropathy ( P < 0.05). Pressure caused by the striated anal sphincter was also inv ersely correlated to PNTML. Pudendal neuropathy was encountered in 37 of 63 (58.7 percent) patients with sphincter injury vs. in 31 of 33 (9 3.9 percent) patients with idiopathic fecal incontinence (P < 0.01). C ONCLUSIONS: Pudendal neuropathy is an etiologic or associated factor o ften present in patients with fecal incontinence. In this sense, clini cal, perineometric, and manometric findings correlate with pudendal ne uropathy, though such explorations do not suffice to detect it.