The role of pelvic neuropathy in the pathogenesis of anal incontinence in patients with pelvic organ prolapse

Fomenko O.Yu., Popov A.A., Biryukov O.M., Kozlov V.A., Fedorov A.A. , Belousova S.V., Aleshin D.V., Mudrov A.A., Efremova E.S., Nekrasov M.A.

1) A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia, Moscow, Russia; 2) Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia; 3) National Research University Higher School of Economics Institute of Demography, Moscow, Russia
Objective. To assess the presence of pudendal neuropathy (PN) and to determine its possible role in the pathogenesis of fecal incontinence in patients with pelvic organ prolapse.
Subjects and methods. Fifty-two patients with pelvic organ prolapse were examined. For diagnosis of PN, stimulation intravaginal electromyography was performed by applying St. Mark’s electrode. The complex sphincterometric technique devised at the A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia, was used to diagnose anal sphincter dysfunction (ASD).
Results. Increased pudendal nerve conduction was reported in 84% of the patients with genital prolapse. All the patients with rectal prolapse were found to have neuropathy and clinical and instrumental signs of ASD. The latter signs of ASD were absent in only 8% of the women with genital prolapse; latent anal incontinence was identified in 16%, which is confirmed by the data of functional studies.
Conclusion. In patients with descent and/or prolapse of the internal genitalia, the significant detection rate of neuropathy raises the question about the site of neuropathy in the pathogenesis of pelvic organ prolapse.

Keywords

pudendal neuropathy
pelvic organ prolapse
stimulation electromyography
latent excitation along the motor fibers of the pudendal nerve
anal sphincter dysfunction

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Received 11.11.2019

Accepted 29.11.2019

About the Authors

Oksana Yu. Fomenko, MD, Associate Professor, Head of the Laboratory of Clinical Pathophysiology, FSBI “SSCK named after A.N. Ryzhikh »Ministry of Health of Russia.
Tel .: +7 (499) 1990655. E-mail: info@gnck.ru, oksana671@yandex.ru orcid.org/0000-0001-9603-6988
123423 Russia, Moscow, Salam Adil St., 2.
Alexander A. Popov, MD, professor, head of the department of endoscopic surgery GBUZ MO MONIIAG. Tel .: +7 (495) 6257332. E-mail: gyn_endoscopy@mail.ru, orcid.org/0000-0003-3692-2421
101000 Russia, Moscow, ul. Pokrovka, d.22a.
Oleg M. Biryukov, candidate of medical sciences, head of the department of general and reconstructive coloproctology, FSBI “SSCC named after A.N. Ryzhikh »Ministry of Health of Russia. Tel .: +7 (499) 1990655. E-mail: info@gnck.ru
123423 Russia, Moscow, Salam Adil St., 2.
Vladimir A. Kozlov, NS Laboratory of Socio-Demographic Policy, Associate Professor, Department of Demography, Institute of Demography, Federal State Autonomous Educational Institution of Higher Education “National Research University Higher School of Economics”, 101000, Moscow, B. Trekhsvyatitelsky per., 3.
E-mail: www.hse.ru, Tel .: +7 (495) 7713232, orcid.org/0000-0003-1788-1484
Anton A. Fedorov, candidate of medical sciences, senior researcher Department of Endoscopic Surgery GBUZ MO MONIIAG. Tel .: +7 (495) 6257332.
E-mail: gyn_endoscopy@mail.ru, orcid.org/0000-0003-2590-5087
101000 Russia, Moscow, ul. Pokrovka, d.22a.
Svetlana V. Belousova, candidate of medical sciences, senior researcher Laboratory of Clinical Pathophysiology FSBI “SSCK named after A.N. Ryzhikh »Ministry of Health of Russia. Tel .: +7 (499) 1990655. E-mail: info@gnck.ru, https://orcid.org/0000-0003-1475-2599
123423 Russia, Moscow, Salyama Adil St., 2.
Denis V. Aleshin, candidate of medical sciences, head of the operblok FSBI “SSCC them. A.N. Ryzhikh »Ministry of Health of Russia. Tel .: +7 (499) 1990655.
E-mail: info@gnck.ru
 123423 Russia, Moscow, Salyama Adil St., 2.
Andrey A. Mudrov, candidate of medical sciences, scientist Department of General and Reconstructive Coloproctology, FSBI “SSCK named after A.N. Ginger »Ministry of Health of Russia, Assistant of the Department of Coloproctology FSBEI DPO RMANPO Ministry of Health of Russia. Tel .: +7 (499) 1990655. E-mail: info@gnck.ru
123423 Russia, Moscow, Salyama Adil St., 2.
Elena S. Efremova, Department of Endoscopic Surgery GBUZ MO MONIIAG. Phone: + 7 (495) 6257332. E-mail: gyn_endoscopy@mail.ru, orcid.org/0000-0002-1438-5701
101000 Russia, Moscow, ul. Pokrovka, d.22a.
Maxim A. Nekrasov, M.S. Laboratory of Clinical Pathophysiology FSBI “SSCK named after A.N. Ryzhikh »Ministry of Health of Russia. Phone: +7 (499) 1990655,
E-mail: info@gnck.ru, orcid.org/0000-0002-5767-0123
123423 Russia, Moscow, Salyama Adil St., 2.

For citation: Fomenko O.Yu., Popov A.A., Biryukov O.M., Kozlov V.A., Fedorov A.A., Belousova S.V., Aleshin D.V., Mudrov A.A., Efremova E.S., Nekrasov M.A. The role of pelvic neuropathy in the pathogenesis of anal incontinence in patients with pelvic organ prolapse.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 2: 141-48. (In Russian).
https://dx.doi.org/10.18565/aig.2020.2.141-148

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