The acute effect of straining on pelvic floor neurological function

Area of Science:

• Neuroscience
• Urology
• Gastroenterology

Background:

• Continence relies on intact sensory and motor functions, with the pudendal nerve playing a crucial role.
• Pudendal neuropathy and altered anal sensation are linked to incontinence, but their correlation with perineal descent is inconsistent.

Purpose of the Study:

• To evaluate the impact of simulated defecation strain on pelvic floor neurological function in patients with constipation and incontinence.
• To investigate the relationship between pudendal nerve terminal motor latency (PNTML), anal electrosensitivity (AS), and perineal descent.

Main Methods:

• Pudendal nerve terminal motor latency (PNTML) and anal electrosensitivity (AS) were measured at rest and after a 1-minute simulated defecation strain.
• Patients with constipation and incontinence were assessed, with measurements taken before and after straining.
• Perineal descent was quantified during straining.

Main Results:

• At rest, PNTML correlated with AS. After straining, AS was significantly blunted and PNTML prolonged, returning to baseline within 3 minutes.
• Greater perineal descent correlated with more pronounced blunting of AS and prolongation of PNTML.
• Age was significantly correlated with both AS and PNTML.

Conclusions:

• Defecation straining acutely affects anal sensation and pudendal nerve motor function.
• These functional changes can occur independently of significant perineal descent and affect both constipated and incontinent individuals.
• Age is a significant factor influencing these neurological parameters.