role of electro-diagnosis and therapy in management of fecal incontinence secondary to anorectal congenital anomalies

ABSTRACT

To assess the diagnostic and prognostic role of electromyography [EMG] of the external anal sphincter and pelvic floor muscles in children born with anorectal anomalies. Also, we tried to assess the role of electric stimulation to the sphincter muscles when applied pre and/or postoperatively in the control of fecal incontinence in those children. Eighty children with congenital anorectal anomalies and ten normal children who served as a control group were enrolled to the study. All were subjected to EMG assessment of the puborectalis [PR], external anal sphincter [EAS] and levator ani [LA]. Accordingly patients were divided into Group I Patients with normal EMG subjected to surgery, [posterior sagittal anorectoplasty] and EMG assessment after surgery. Group II Patients with reduced electric activity of EMG. They were subjected to pre and postoperative electric stimulation and EMG before and after electric stimulation with postoperative EMG assessment. Group III Patients with reduced EMG; they were operated with no electric stimulation with post-op. EMG assessment. Group IV Patients with post operative fecal incontinence before being included in the study they were subjected to electric stimulation and post electric stimulation EMG assessment. EMG- showed a reduced value of the mean amplitude/turn [M] and number of turns/sec [T] value in the clinically weak muscles. M value was a more sensitive EMG parameter than T value in assessment of sphincter muscle activity. Electrophysiological stimulation showed significant clinical and EMG improvement in the studied groups in the PR, EAS and LA muscles. EMG can be a good diagnostic and prognostic measure in the assessment of EA, PR and LA muscles. Electric stimulation had a valuable role in strengthening the sphincteric muscles before and after correction, especially if combined, and in the conservative management of older incontinent children