Skip to main content
Erschienen in: Diseases of the Colon & Rectum 11/2008

01.11.2008 | Original Contribution

Experimental Models of Neuropathic Fecal Incontinence: An Animal Model of Childbirth Injury to the Pudendal Nerve and External Anal Sphincter

verfasst von: C. F. Healy, M.R.C.S., C. O’Herlihy, M.D., C. O’Brien, M.D., P. R. O’Connell, M.D., J. F. X. Jones, Ph.D.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 11/2008

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Childbirth is the most common cause of fecal incontinence and damage to the pudendal nerve is a major component of childbirth injury. This study was designed to develop an acute animal model of injury to the innervation of the external anal sphincter.

Methods

Forty-eight female virgin wistar rats were studied. Two models of neuropathic injury were developed. Bilateral inferior rectal nerve crush (Group A) acted as a positive control. Prolonged intrapelvic retrouterine balloon inflation (Group B) simulated the pelvic compressive forces of labor. Quantitative analysis of external anal sphincter muscle function was performed by using electromyography, external anal sphincter specific force production, and stereologic calculation of external anal sphincter mass.

Results

Injury in both groups caused significant atrophy of the external anal sphincter (P = 0.002, ANOVA) and electromyographic evidence of reinnervation at one week. Specific force (mN force per mg mass) was not altered. External anal sphincter muscle mass recovered after four weeks in Group B.

Conclusions

Balloon dilation within the boney pelvis results in denervation of the external anal sphincter and offers an experimental model of the effects of childbirth on the continence mechanism in humans.
Literatur
1.
Zurück zum Zitat Whitehead WE. Diagnosing and managing fecal incontinence: if you don’t ask they won’t tell. Gastroenterology 2005;129:6.PubMedCrossRef Whitehead WE. Diagnosing and managing fecal incontinence: if you don’t ask they won’t tell. Gastroenterology 2005;129:6.PubMedCrossRef
2.
Zurück zum Zitat Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology 2005;129:42–9.PubMedCrossRef Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology 2005;129:42–9.PubMedCrossRef
3.
Zurück zum Zitat Mellgren A, Jensen LL, Zetterstrom JP, Wong WD, Hofmeister JH, Lowry AC. Long-term cost of fecal incontinence secondary to obstetric injuries. Dis Colon Rectum 1999;42:857–65.PubMedCrossRef Mellgren A, Jensen LL, Zetterstrom JP, Wong WD, Hofmeister JH, Lowry AC. Long-term cost of fecal incontinence secondary to obstetric injuries. Dis Colon Rectum 1999;42:857–65.PubMedCrossRef
4.
Zurück zum Zitat Whitehead WE, Wald A, Norton NJ. Priorities for treatment research from different professional perspectives. Gastroenterology 2004;126:S1980–5.CrossRef Whitehead WE, Wald A, Norton NJ. Priorities for treatment research from different professional perspectives. Gastroenterology 2004;126:S1980–5.CrossRef
5.
Zurück zum Zitat Borrie MJ, Davidson HA. Incontinence in institutions: costs and contributing factors. CMAJ 1992;147:322–8.PubMed Borrie MJ, Davidson HA. Incontinence in institutions: costs and contributing factors. CMAJ 1992;147:322–8.PubMed
6.
Zurück zum Zitat Snooks SJ, Swash M, Setchell M, Henry M. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546–50.PubMedCrossRef Snooks SJ, Swash M, Setchell M, Henry M. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546–50.PubMedCrossRef
7.
Zurück zum Zitat Kiff ES, Swash M. Slowed conduction in the pudendal nerve in idiopathic neurogenic faecal incontinence. Br J Surg 1984;71:614–6.PubMedCrossRef Kiff ES, Swash M. Slowed conduction in the pudendal nerve in idiopathic neurogenic faecal incontinence. Br J Surg 1984;71:614–6.PubMedCrossRef
8.
Zurück zum Zitat Snooks SJ, Henry MM, Swash M. Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology. Br J Obstet Gynaecol 1985;92:824–8.PubMed Snooks SJ, Henry MM, Swash M. Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology. Br J Obstet Gynaecol 1985;92:824–8.PubMed
9.
Zurück zum Zitat Swash M, Snooks SJ, Chalmers DH. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 1987;44:504–8.PubMed Swash M, Snooks SJ, Chalmers DH. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 1987;44:504–8.PubMed
10.
Zurück zum Zitat Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C. Obstetric events leading to anal sphincter damage. Obstet Gynecol 1998;92:955–61.PubMedCrossRef Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C. Obstetric events leading to anal sphincter damage. Obstet Gynecol 1998;92:955–61.PubMedCrossRef
11.
Zurück zum Zitat Fitzpatrick M, O’Brien C, O’Connell PR, O’Herlihy C. Patterns of abnormal pudendal nerve function that are associated with postpartum faecal incontinence. Am J Obstet Gynecol 2003;189:730–5.PubMedCrossRef Fitzpatrick M, O’Brien C, O’Connell PR, O’Herlihy C. Patterns of abnormal pudendal nerve function that are associated with postpartum faecal incontinence. Am J Obstet Gynecol 2003;189:730–5.PubMedCrossRef
12.
Zurück zum Zitat Kerns JM, Damaser MS, Kane JM, et al. Effect of pudendal nerve injury in the female rat. Neurourol Urodyn 2000;19:53–69.PubMedCrossRef Kerns JM, Damaser MS, Kane JM, et al. Effect of pudendal nerve injury in the female rat. Neurourol Urodyn 2000;19:53–69.PubMedCrossRef
13.
Zurück zum Zitat Cannon W, Wojcik EM, Ferguson CL, Saraga S, Thomas C, Damaser MS. Effects of vaginal distension on urethral anatomy and function. B J Urol Int 2002;90:403–7. Cannon W, Wojcik EM, Ferguson CL, Saraga S, Thomas C, Damaser MS. Effects of vaginal distension on urethral anatomy and function. B J Urol Int 2002;90:403–7.
14.
Zurück zum Zitat Damaser MS, Broxton-King C, Ferguson K, Fim FJ, Kerns JM. Functional and neuroanatomical effects of vaginal distension and pudendal nerve crush in the female rat. J Urol 2003;170:1027–31.PubMedCrossRef Damaser MS, Broxton-King C, Ferguson K, Fim FJ, Kerns JM. Functional and neuroanatomical effects of vaginal distension and pudendal nerve crush in the female rat. J Urol 2003;170:1027–31.PubMedCrossRef
15.
Zurück zum Zitat Congilosi SM, Johnson DR, Medot M, et al. Experimental model of pudendal nerve innervation of a skeletal muscle neosphincter for faecal incontinence. Br J Surg 1997;84:1269–73.PubMedCrossRef Congilosi SM, Johnson DR, Medot M, et al. Experimental model of pudendal nerve innervation of a skeletal muscle neosphincter for faecal incontinence. Br J Surg 1997;84:1269–73.PubMedCrossRef
16.
Zurück zum Zitat Rempen A, Kraus M. Measurement of head compression during labour: preliminary results. J Perinat Med 1991;19:115–20.PubMedCrossRef Rempen A, Kraus M. Measurement of head compression during labour: preliminary results. J Perinat Med 1991;19:115–20.PubMedCrossRef
17.
Zurück zum Zitat Blaivas JG, Labib KL, Bauer SB, Retik AB. Changing concepts in the urodynamic evaluation of children. J Urol 1977;117:778–81.PubMed Blaivas JG, Labib KL, Bauer SB, Retik AB. Changing concepts in the urodynamic evaluation of children. J Urol 1977;117:778–81.PubMed
18.
Zurück zum Zitat Parks AG, Swash M, Urick H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.PubMedCrossRef Parks AG, Swash M, Urick H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.PubMedCrossRef
19.
Zurück zum Zitat Neill ME, Swash M. Increased motor unit fibre density in the external anal sphincter in ano-rectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psych 1980;43:343–7.CrossRef Neill ME, Swash M. Increased motor unit fibre density in the external anal sphincter in ano-rectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psych 1980;43:343–7.CrossRef
20.
Zurück zum Zitat Allen RE, Hosker GL, Smith AR, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 1990;97:770–9.PubMed Allen RE, Hosker GL, Smith AR, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 1990;97:770–9.PubMed
21.
Zurück zum Zitat Kanje M. Survival and regeneration of the adult rat vagus nerve in culture. Brain Res 1991;550:340–2.PubMedCrossRef Kanje M. Survival and regeneration of the adult rat vagus nerve in culture. Brain Res 1991;550:340–2.PubMedCrossRef
22.
Zurück zum Zitat Swash M. Electrophysiological investigation of the posterior pelvic floor musculature. In: Pemberton JH, Swash M, Henry MM. The pelvic floor: its function and disorders. London: Saunders, 2002:213–36. Swash M. Electrophysiological investigation of the posterior pelvic floor musculature. In: Pemberton JH, Swash M, Henry MM. The pelvic floor: its function and disorders. London: Saunders, 2002:213–36.
23.
Zurück zum Zitat Lin AS, Carrier S, Morgan DM, Lue TF. Effect of simulated birth trauma on the urinary continence mechanism in the rat. Urology 1998;52:143–51.PubMedCrossRef Lin AS, Carrier S, Morgan DM, Lue TF. Effect of simulated birth trauma on the urinary continence mechanism in the rat. Urology 1998;52:143–51.PubMedCrossRef
24.
Zurück zum Zitat Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005;106:707–12.PubMed Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005;106:707–12.PubMed
25.
Zurück zum Zitat Petros PE. Cure of urinary and fecal incontinence by pelvic ligiament reconstruction suggests a connective tissue etiology for both. Int J Urogynec 1999;10:356–60.CrossRef Petros PE. Cure of urinary and fecal incontinence by pelvic ligiament reconstruction suggests a connective tissue etiology for both. Int J Urogynec 1999;10:356–60.CrossRef
26.
Zurück zum Zitat Sakamoto K, Smith GM, Storer PD, Jones KJ, Damaser MS. Neuroregeneration and voiding behaviour patterns after pudendal nerve crush in female rats. Neurourol Urodyn 2000;19:311–21.PubMedCrossRef Sakamoto K, Smith GM, Storer PD, Jones KJ, Damaser MS. Neuroregeneration and voiding behaviour patterns after pudendal nerve crush in female rats. Neurourol Urodyn 2000;19:311–21.PubMedCrossRef
27.
Zurück zum Zitat Keane DP, Simms TJ, Abrams P, Bailey AJ. Analysis of collagen status in premenopausal women with genuine stress incontinence. Br J Obstet Gynaecol 1997;104:994–8.PubMed Keane DP, Simms TJ, Abrams P, Bailey AJ. Analysis of collagen status in premenopausal women with genuine stress incontinence. Br J Obstet Gynaecol 1997;104:994–8.PubMed
1.
Zurück zum Zitat Lin AS, Carrier S, Morgan DM, Lue TF. Effect of simulated birth trauma on the urinary continence mechanism in the rat Urology 1998;52:143–51.PubMedCrossRef Lin AS, Carrier S, Morgan DM, Lue TF. Effect of simulated birth trauma on the urinary continence mechanism in the rat Urology 1998;52:143–51.PubMedCrossRef
2.
Zurück zum Zitat Sievert KD, Emre Bakircioglu M, Tsai T, Dahms SE, Numes L, Lue TF. The effects of simulated birth trauma and/or ovariectomy on rodent continence mechanisms. Part 1.: functional and structural change. J Urol 2001;166:311–7.PubMed Sievert KD, Emre Bakircioglu M, Tsai T, Dahms SE, Numes L, Lue TF. The effects of simulated birth trauma and/or ovariectomy on rodent continence mechanisms. Part 1.: functional and structural change. J Urol 2001;166:311–7.PubMed
Metadaten
Titel
Experimental Models of Neuropathic Fecal Incontinence: An Animal Model of Childbirth Injury to the Pudendal Nerve and External Anal Sphincter
verfasst von
C. F. Healy, M.R.C.S.
C. O’Herlihy, M.D.
C. O’Brien, M.D.
P. R. O’Connell, M.D.
J. F. X. Jones, Ph.D.
Publikationsdatum
01.11.2008
Verlag
Springer-Verlag
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 11/2008
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-008-9283-7

Weitere Artikel der Ausgabe 11/2008

Diseases of the Colon & Rectum 11/2008 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.