Top

Diseases of the Colon & Rectum

Published in:

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

Authors: 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.

Published in: Diseases of the Colon & Rectum | Issue 11/2008

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.

Whitehead WE. Diagnosing and managing fecal incontinence: if you don’t ask they won’t tell. Gastroenterology 2005;129:6.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

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

Whitehead WE, Wald A, Norton NJ. Priorities for treatment research from different professional perspectives. Gastroenterology 2004;126:S1980–5.CrossRef

Borrie MJ, Davidson HA. Incontinence in institutions: costs and contributing factors. CMAJ 1992;147:322–8.PubMed

Snooks SJ, Swash M, Setchell M, Henry M. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546–50.PubMedCrossRef

Kiff ES, Swash M. Slowed conduction in the pudendal nerve in idiopathic neurogenic faecal incontinence. Br J Surg 1984;71:614–6.PubMedCrossRef

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

Swash M, Snooks SJ, Chalmers DH. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 1987;44:504–8.PubMed

10.

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.

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.

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.

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.

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.

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.

Rempen A, Kraus M. Measurement of head compression during labour: preliminary results. J Perinat Med 1991;19:115–20.PubMedCrossRef

17.

Blaivas JG, Labib KL, Bauer SB, Retik AB. Changing concepts in the urodynamic evaluation of children. J Urol 1977;117:778–81.PubMed

18.

Parks AG, Swash M, Urick H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.PubMedCrossRef

19.

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.

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.

Kanje M. Survival and regeneration of the adult rat vagus nerve in culture. Brain Res 1991;550:340–2.PubMedCrossRef

22.

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.

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.

Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol 2005;106:707–12.PubMed

25.

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.

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.

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

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

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

Title: Experimental Models of Neuropathic Fecal Incontinence: An Animal Model of Childbirth Injury to the Pudendal Nerve and External Anal Sphincter
Authors: 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.
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 11/2008
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-008-9283-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2008

Laparoscopic-Assisted Rectosigmoidectomy with Ileal Loop Interposition. Surgical Treatment of Chagasic Megacolon

Self-assessment Quiz: Answers, Critiques, and References

Outcomes of Stapled Transanal Rectal Resection vs. Biofeedback for the Treatment of Outlet Obstruction Associated with Rectal Intussusception and Rectocele: A Multicenter, Randomized, Controlled Trial

Effect of Mosapride on Recovery of Intestinal Motility After Hand-Assisted Laparoscopic Colectomy for Carcinoma

Evaluation of Calgranulin B in Stools from the Patients with Colorectal Cancer

Obstructive Complications of Laparoscopically Created Defunctioning Ileostomy