Quantitative electromyographic analysis of levator ani and external anal sphincter muscles of nulliparous women.

OBJECTIVES: Our aims were to introduce a method of digital quantitative electromyography of the levator ani and external anal sphincter muscles and to establish reference values. STUDY DESIGN: Fifteen nulliparous, symptom-free women underwent concentric needle electromyographic examination of the levator ani and external anal sphincter. We sampled the levator ani transvaginally at 4 sites and the external anal sphincter at 2 sites. The signal was filtered and amplified, and digital recordings were made at 3 levels of voluntary activation at each site. Analyses of motor unit action potentials and interference patterns were performed with the use of these taped signals. Normal ranges were generated and compared with those established for other striated muscles. RESULTS: The mean age of the subjects was 28.7+/-7.5 years. A median of 24 motor unit action potentials was recorded in each levator ani, and a median of 6 was recorded in each external anal sphincter. Parameters of the levator ani action potentials were significantly greater than those of the external anal sphincter in amplitude (0.48 vs. 0.37 mV; P =.001), duration (10.40 vs. 8.27 ms; P =.002), number of turns per second (2. 80 vs. 2.28; P<.001), and area (0.65 vs. 0.36; P<.001). Parameters of the interference patterns were significantly greater in the levator ani than in the external anal sphincter in number of turns per second (241.6 vs. 183.9; P =.015), amplitude (302.7 vs. 225.3 microV; P<.0001), activity (95.6 vs 61.2; P =.004), envelope size (861.1 vs 567.6 microV; P<.0001), and number of small segments (105. 8 vs 81.4; P =.047). There were no significant differences between levator ani, external anal sphincter, and published parameters from the biceps muscle with regard to amplitude and duration of motor unit action potentials. CONCLUSIONS: Electromyography of the levator ani and external anal sphincter is feasible and well tolerated. Our findings confirm that the levator ani muscle has larger, more readily recruited motor units than does the external anal sphincter. Ranges for important quantitative electromyographic parameters for these muscles are similar to those published for the biceps.

Duke Scholars

Author Alison Catherine Weidner Obstetrics and Gynecology, Urogynecology

Author Donald Benjamin Sanders Neurology, Neuromuscular Disease