Pelvic floor EMG is a procedure used to diagnose urinary bladder voiding disorders. The function and activity of the musculature can be recorded and thus pathological changes can be detected.
What is pelvic floor EMG?
A pelvic floor EMG is applied to diagnose micturition disorders, a stress incontinence, anal incontinence or even constipation (constipation). Pelvic floor EMG is an electromyography of the pelvic floor muscles. Electromyography is considered an additional examination to uroflowmetry and is used to quantify and subsequently assess the pelvic floor muscles. Uroflowmetry includes various examination methods for diagnosing bladder emptying disorders. During the examination by means of pelvic floor electromyography, muscle action potentials of the striated pelvic floor muscles and the sphincter muscles (sphincter) are recorded. Muscle action potentials are electrical impulses triggered by muscle activity. The recordings of the muscle action potential are called electromyograms. In addition to being used for diagnostic purposes, this examination method, with the appropriate additional utensils such as an acoustic amplifier or a monitor, can be used for therapeutic purposes. Here, the focus is on the so-called biofeedback training. This type of training is used to measure the function of the pelvic floor, which is usually not consciously perceptible, and to provide feedback to the patient. The patient can use this feedback to influence the measurement result and, for example, increase or decrease the muscle tension of the pelvic floor.
Function, effect, and goals
A pelvic floor EMG is applied for the diagnosis of micturition disorders, stress incontinence, anal incontinence or even constipation (constipation). When examining micturition disorders, no contrast medium is used during pelvic floor electromyography and therefore carries fewer risks than other examination methods. Stress incontinence, also known as stress incontinence, is investigated using a needle EMG. Through the EMG, a qualitative and quantitative assessment of micturition can be made and a possible cause of incontinence can be found. Furthermore, this diagnostic procedure is also used outside of urology in the area of anal incontinence to assess anal dysfunction. In addition, it is still used in proctology, for the investigation of a possible pathological opstipation (constipation). The flow EMG procedure for the assessment of a present micturition disorder is one of the most important screening procedures. It should always be kept in mind that depending on age and gender, micturition values vary. Therefore, the patient’s medical history is very important to provide a meaningful assessment. In order to achieve an adequate result by the pelvic floor electromyography procedure, the correct positioning of the electrodes is particularly important. In order to derive the corresponding muscle action potentials, an adhesive electrode must be placed in the area of the anus and one as a grounding electrode (indifferent electrode) on the thigh. In so-called needle pelvic floor EMG, no adhesive electrodes are used, but needle electrodes. These are placed directly in the tissue. A 2-channel recorder is used to record the muscle action potentials. During a micturition phase, this records a urinary flow curve and the function of the pelvic floor muscles. A urological specialist can make an assessment on micturition behavior based on these values and the patient’s medical history. There are different procedures for pelvic floor electromyography. In general, this procedure can be used to assess the complete striated musculature of the pelvic floor. However, two ways of application are distinguished. On the one hand, there is the non-specific surface EMG and the simple surface EMG. This is usually sufficient for general assessments of a functional disorder. If specific examinations are to be carried out with the EMG, a rather complex needle EMG is performed. This achieves specific and more meaningful results than the surface EMG. However, although this procedure produces the better results, it is rarely performed. The reason for this is that it is significantly more painful and carries more risks.Nevertheless, in some cases a needle EMG is of high importance, since the spontaneous activity of the individual muscles is also recorded separately. This is advantageous if neurological dysfunctions or scarring in the pelvic floor area are present or are to be detected. In principle, the pelvic floor EMG procedure is not sufficiently informative as a sole examination to make a conclusive possible diagnosis. The values vary too much due to the external conditions, which not only concern the medical history (age, previous illnesses), but also the individual tissue structures and the predisposition in their function. Therefore, EMG is considered as a diagnostic procedure of many from uroflowmetry. As a sole examination, the results of electromyography are not sufficient and the assessment is therefore vague. When assessing the results of the measurement, the specialist pays attention to the function of the urinary bladder. Physiological activity is observed by an increase in muscle tension parallel to the filling of the urinary bladder. Increased or insufficient activity of the urinary bladder is called pathological. During emptying of the bladder, there is relaxation of the sphincter muscles. As a result, the sphincter muscle is opened and urine can be evacuated. During this phase, an electromyogram should record minimal or, in the best case, no action potentials of the muscles. If other values are revealed, this may indicate a pathologic neurologic finding. The pelvic floor muscles and sphincter cannot be triggered with appropriate neurologic stimuli from the nerves.
Risks, side effects, and hazards
In general, complications with pelvic floor EMG occur only in very rare, exceptional cases. Surface electromyography does not carry any risks or subsequent complications; very rarely, skin irritation may occur due to the adhesive electrodes, which quickly recedes with wound ointments. In very rare cases, needle electromyography may cause complications. Injury to the nerves or blood vessels may occur when the needle electrodes are placed in the tissue, but this occurs so rarely that it can almost be considered hypothetical.
