Pudendal nerve function in idiopathic fecal incontinence

PURPOSE: The study was undertaken to determine whether idiopathic fecal inc ontinence in middle-aged and elderly females is likely to be a result of pu dendal nerve damage (neurogenic incontinence) or merely a consequence of ag ing. METHODS: One hundred seventy-eight females over the age of 50 years wi th fecal incontinence were studied. The incontinence was classified as idio pathic because none of the patients related the incontinence to trauma (inc luding obstetric trauma) or other events or diseases. AU had an anal physio logy examination, including determination of nerve conduction velocity of b oth pudendal nerves (pudendal nerve terminal motor latency). RESULTS: With a cutoff value of 2.4 msec, 79 percent (95 percent confidence limit, 73-85) had normal pudendal nerve terminal motor latency on both sides, 13 bilater ally prolonged latency (7 percent; 4-11), and 25 unilaterally prolonged lat ency (14 percent; 9-19). With a cutoff value of 2.2 msec, Gb percent (59-73 ) had normal latency on both sides, 15 percent (9-20) bilaterally prolonged pudendal nerve terminal motor latency, and 20 percent (14-26) unilateral p rolongation. No relationship between the groups with normal, bilateral, or unilateral prolongation of pudendal nerve terminal motor latency and anal r esting and squeeze pressure was found. Anal resting pressure decreased with increasing age (P < 0.05). CONCLUSION: Our data support the view that idio pathic fecal incontinence in the majority of females is likely to be a resu lt of the aging process and that only a limited number may suffer from anal incontinence of neurogenic origin. Furthermore, unilateral prolongation of pudendal nerve terminal motor latency probably is without clinical signifi cance.