title: Pudendal neuropathy is not related to physiologic pelvic outlet obstruction.
abstract: Chronic straining because of pelvic outlet obstruction is hypothesized to cause pudendal neuropathy (PN) by stretch injury.
  
  
  OBJECTIVE
  The aim of this study was to determine any association between PN and pelvic outlet obstruction.
  
  
  METHODS
  One hundred forty-seven constipated patients were evaluated by cinedefecography and pudendal nerve terminal motor latency assessment. PN was defined as a latency longer than 2.2 ms. Pelvic outlet obstructive patterns of evacuation included paradoxic contraction, nonrelaxation of the puborectalis muscle, or failure of opening of the anal canal.
  
  
  RESULTS
  Median length of constipation including straining during evacuation was eight (range, 1-47) years. Ninety-one (62 percent) subjects had a normal pattern of evacuation, and 56 (38 percent) had an obstructed pattern. Both groups had a similar median age (68 vs. 69 years, respectively; P > 0.05) and same median length of symptoms. Overall incidence of PN was 23.8 percent (10.9 percent unilateral and 12.9 percent bilateral). There was no difference in the incidence of PN between patients with normal evacuation and patients with obstructed evacuation (24.2 percent vs. 23.2 percent, respectively; P > 0.05). Patients with PN had a similar incidence of physiologic pelvic outlet obstruction as did patients without PN. However, median age of patients with PN was higher than those without PN (73 vs. 66 years, respectively; P > 0.05).
  
  
  CONCLUSIONS
  There was a difference in the incidence of PN between normal and obstructed patterns of evacuation. Therefore, the espoused theory that obstructed defecation causes PN appears flawed.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida 33309, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Vaccaro
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
authors.forename: T A
authors.initials: TA
authors.lastname: Teoh
authors.forename: S K
authors.initials: SK
authors.lastname: Choi
authors.forename: D M
authors.initials: DM
authors.lastname: Cheong
authors.forename: V D
authors.initials: VD
authors.lastname: Salanga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D002908:Chronic Disease; D003248:Constipation / Q000150:complications / Q000503:physiopathology*; D003672:Defecation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000503:physiopathology; D009431:Neural Conduction; D010388:Pelvis; D010523:Peripheral Nervous System Diseases / Q000209:etiology*; D012007:Rectum / Q000294:innervation*