Meegdenburg, M. van (Maxime) (2014) Different innervations for conscious and autonomic external anal sphincter contraction: analysis of fecal incontinent patients. thesis, Medicine.
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Abstract
Background. The current understanding is that the conscious contraction of the striated external anal sphincter is controlled by the pudendal nerve. It is not yet known whether the part of the external sphincter that is autonomically contracted by the anal-external sphincter continence reflex is also innervated by the pudendal nerve. Methods. Retrospectively, we reviewed the medical records of fifty-three adult patients with pudendal neuropathy and of seventeen adult patients without pudendal neuropathy who all had undergone thorough anorectal function tests between 2010 and 2013. The study was conducted at University Medical Center Groningen, the Netherlands. Results. Patients in the pudendal neuropathy group were significantly older than patients in the group without pudendal neuropathy (median: 41 versus 60 years, P = .013). Maximum sphincter contractility, i.e., conscious control of the external sphincter, was significantly lower in patients with pudendal neuropathy compared with patients without pudendal neuropathy (median: 165 versus 235 mmHg, P = .007). In contrary, pressure in the anal canal at maximum tolerable or retainable sensation, i.e., autonomic control of the external sphincter, was not significantly different between the pudendal neuropathy group and the group without pudendal neuropathy (median: 78 versus 118 mmHg). Additionally, the results showed that there was no relation between maximum sphincter contractility and pressure in the anal canal at maximum tolerable or retainable volume between the two groups. Multiple and simple linear regression analyzes demonstrated that age and pudendal neuropathy significantly predicted maximum sphincter contractility, but not pressure in the anal canal at maximum tolerable or retainable sensation. Conclusion. The autonomic contraction of the external sphincter is at least innervated by another part of the pudendal nerve as the conscious contraction, presumably not even by the pudendal nerve. It is not yet known which nerve is responsible for the autonomic contraction of the external sphincter. Perhaps, it might be innervated directly by the fourth sacral nerve.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Broens, Dr. P.M.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/85 |
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