title: Compound muscle action potential of the external anal sphincter.
abstract: OBJECTIVE
  Pudendal nerve terminal motor latency (PNTML) assesses distal innervation of the external anal sphincter (EAS) but it is insensitive to early nerve damage. We propose to extend the assessment of PNTML to the measurement of the compound muscle action potential (CMAP) of the EAS to understand its progressive denervation.
  
  
  METHODS
  Ninety women with faecal incontinence were prospectively examined and compared with 36 asymptomatic women who acted as controls. PNTML was performed bilaterally and the muscle response analysed for CMAP to include amplitude, area and duration. Anorectal manometry was measured by a station-pull technique using a water-filled microballoon. spss version 11.5 was used for statistical analysis.
  
  
  RESULTS
  In asymptomatic women the CMAP on the left side was greater in nulliparous (n = 7) than parous (n = 27, P < 0.05) individuals. There was a positive correlation with maximum squeeze pressure and area on the left side (P < 0.05, r = 0.397). In women with faecal incontinence, CMAP on the left side had a negative correlation with age (n = 75, P < 0.05), there was no correlation with parity or anorectal manometry. Nulliparous asymptomatic women had a greater CMAP (P < 0.05) on the left side than asymptomatic parous women and parous women with faecal incontinence. Right-side measurements were not conclusive.
  
  
  CONCLUSIONS
  Compound muscle action potential demonstrated progressive denervation with age in women with faecal incontinence but did not reliably identify early signs of denervation in asymptomatic women. The area on the left side related to muscle function in asymptomatic women but not in women with faecal incontinence. CMAP can distinguish between parous women with faecal incontinence and nulliparous asymptomatic women but is not a useful test of function of the EAS.
authors.affiliation: Colorectal Surgery, South Manchester NHS Trust, Manchester, UK; Warrell Unit, St Mary's Hospital, Manchester, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Nockolds
authors.forename: G L
authors.initials: GL
authors.lastname: Hosker
authors.forename: E S
authors.initials: ES
authors.lastname: Kiff
mesh_terms: D000200:Action Potentials; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology*; D016022:Case-Control Studies; D005242:Fecal Incontinence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D010298:Parity / Q000502:physiology; D011446:Prospective Studies; D060525:Pudendal Nerve / Q000503:physiopathology*; D055815:Young Adult
keywords: Faecal incontinence; anal; functional; pathophysiology; pudendal neuropathy