The Strength Duration Test: a Novel Tool in the Identification of Occult Neuropathy in Women with Pelvic Floor Dysfunction.

OBJECTIVE:The Strength-duration test (SDT) is a simple minimally invasive measure of muscle innervation, recently adapted for the assessment of the external anal sphincter (EAS). This test can discriminate women with faecal incontinence from controls. The purpose of this study was to determine if the SDT could detect denervation of the EAS in women with weak but anatomically intact EAS and normal pudendal nerve terminal motor latency (PNTML).PATIENTS AND METHODS:Thirteen women with weak but intact EAS on endoanal ultrasound (EAUS) with normal maximum resting pressure and PNTML were recruited to undergo the SDT. The results from this group were compared to control data for the SDT previously collected in our unit.RESULTS:Nine of 13 women were found to have SDT above a 95% confidence interval of the mean curve for controls and six had a SDT outside a 90% confidence interval for individuals derived from control data, suggesting denervation of the EAS. The mean area under the curve was significantly higher in our study group compared to controls (91.0 microsmA vs 72.2 microsmA, P = 0.047) as was the current intensity measured at the 1 ms pulse duration (18.2 mA vs 12.94 mA, P = 0.048), typical of denervation with this test.CONCLUSION:The SDT was abnormal in nine of the 13 study patients. This may partly explain reduced maximum voluntary contraction seen in this group of patients. SDT may be a more sensitive tool in detecting neuropathy than latency measurement.