Neurologic cause of idiopathic incontinence
S. Laurberg, M. Swash, S. J. Snooks and M. M. Henry
Sir Alan Parks Physiology Unit, St Mark's Hospital, London, England.
The relationship between the pudendal and perineal nerve terminal motor
latencies and descent (weakness) of the perineum on straining was
investigated in 31 patients with idiopathic fecal incontinence, and in 30
patients with double incontinence. Pelvic floor descent was correlated with
increased pudendal nerve terminal motor latency in both groups of patients.
In the patients with double incontinence, there was a less significant
correlation between perineal descent and increased perineal nerve terminal
motor latency. In the patients with fecal incontinence, but without urinary
incontinence, there was no correlation between perineal descent and
perineal nerve terminal motor latency. These data support the concept that
pelvic floor weakness can result in damage to the pudendal and perineal
nerves, leading to fecal and urinary incontinence. In patients with
isolated fecal incontinence the perineal nerves are relatively spared. Thus
these common types of incontinence probably have a neurologic cause, and
neurophysiologic methods can be used in their assessment.
