Clinical neurophysiology and electrodiagnostic testing of the pelvic floor

Normal pelvic floor function depends on a complex interaction between the anatomic support and the neuromuscular function of the pelvic structures. It is fascinating that humans, particularly women, can retain the intrapelvic location of their pelvic viscera, control their urination and defecation, and engage in sexual intercourse, given the upright stature and the dramatic impact of parturition on the pelvic floor. Pelvic floor disorders, including prolapse, urinary and fecal incontinence, and disorders of defecation and micturition, are common. Given current demographics, with a growing aging population, the prevalence of pelvic floor disorders will increase dramatically. Little progress has been made in the management of these conditions, especially addressing them as a dysfunction of anatomic support. Today, clinicians have a better understanding of the normal and altered neuromuscular function and have techniques to characterize and quantify this function better. There is conflicting but growing evidence to support the clinical usefulness of pelvic floor electrodiagnostic testing. Retrospective cohort studies show that pudendal nerve testing gives meaningful clinical information. Patients with fecal incontinence and no evidence of pudendal neuropathy have better surgical outcomes compared with patients with evidence of nerve damage. Only through well-controlled, prospective studies that include outcome measures would it be possible to ascertain the validity and reliability of these measures of neuromuscular function.