Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence.
Twenty one patients with diabetic peripheral neuropathy, 18 with idiopathic faecal incontinence and 11 normal controls were studied with techniques of mucosal electrosensitivity, rectal distension for the quantitative assessment of anorectal sensation, and manometric and electromyographic tests for the assessment of anorectal motor function. An asymptomatic sensorimotor deficit was found in the anal canal of patients with diabetic peripheral neuropathy. Mucosal electrosensitivity thresholds in the anal canal were significantly higher (p less than 0.01 v controls) and fibre density of the external anal sphincter significantly raised (p less than 0.0001 v controls). Anal manometry and pudendal nerve terminal motor latencies were similar to controls. In patients with idiopathic faecal incontinence the tests of sensory and motor function also showed a sensorimotor neuropathy; compared with controls, mucosal electrosensitivity thresholds were significantly higher (p less than 0.002), anal canal resting and maximum squeeze pressures were significantly lower (p less than 0.05 and p less than 0.002 respectively), and pudendal nerve terminal motor latencies and fibre density of the external anal sphincter were significantly raised (both p less than 0.05). Sensory thresholds to rectal distension were similar in all groups. Pelvic floor sensorimotor neuropathy in diabetic patients has several features in common with that of patients with idiopathic faecal incontinence but its functional significance remains uncertain.
Rogers
J
J
Department of Gastroenterology, Central Middlesex Hospital, London.
Levy
D M
DM
Henry
M M
MM
Misiewicz
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004594:Electrophysiology; D005242:Fecal Incontinence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011930:Reaction Time; D012007:Rectum / Q000294:innervation / Q000503:physiopathology*; D012684:Sensory Thresholds