External Sphincter Electromyography
External sphincter electromyography helps physicians determine how well the external urinary sphincter muscle is working by measuring the electrical activity in it during contraction and relaxation.
The external sphincter muscle is the ring-like muscle that controls urine release from the bladder. When a patient cannot voluntarily control urination (incontinence), a physician may order this test to determine if the problem is caused by the failure of this muscle. The voluntary contraction or release of a muscle such as the external sphincter involves a complex process in which the nerves controlling the muscle signal it to move through the release and uptake of chemicals called neurotransmitters and the generation of electrical impulses. This test records the electrical impulses given off when the muscle contracts or relaxes and allows the physician to determine if the muscle is working properly, if it has been damaged by disease, or some other condition.
Patients who are taking muscle relaxants or drugs that act like or have an effect on the neurotransmitter acetylcholine (cholinergic or anti-cholinergic drugs) should tell the doctor since they will change the test results. The results will also be altered if the patient moves during the test or if the electrodes are improperly placed.
The patient puts on a surgical gown and lies down on the examining table. The procedure, which takes between 30–60 minutes, may be conducted one of three ways:
- Skin electrodes. This is the most commonly used method of recording information. The skin where the electrodes will be placed is cleaned and shaved and an electrically conductive paste is applied. The electrodes are then taped in place. For female patients, the electrodes are taped around the urethra, while for male patients they are placed between the scrotum and the anus.
- Needle electrodes. This is considered the most accurate method, since the electrodes are inserted directly into the muscle, using needles to guide placement. For male patients, a gloved finger is inserted in the rectum, then needles with wires attached are inserted through the skin between the anus and the scrotum. For female patients, the needles are inserted around the urethra. The discomfort of placing the needles is about the same as that of an injection. The needles are withdrawn, and the wires are taped to the thigh.
- Anal plug electrodes. The tip of an anal plug is lubricated and inserted into the rectum as the patient relaxes the anal sphincter. Electrodes are attached to the anal plug.
Once the electrodes are in place and attached to the recording device, the patient is asked to alternately contract and relax the external sphincter muscle. The electrical activity generated during these contractions and relaxations is recorded on a graph called an electromyogram.
Before the test, the patient should discuss with the doctor whether it is necessary to temporarily discontinue any medications, and follow the doctor's orders. No changes in diet or activity are necessary.
Women may see some blood in their urine the first time they urinate after the test. Blood in the urine of men or blood in the urine of women after the first urination should be reported the doctor. The patient should take a warm bath and drink plenty of fluids to ease any discomfort after the test.
Complications of external sphincter electromyography are rare. Occasionally patients report blood in their urine after being tested with needle electrodes. Also, the urethra may become mildly irritated causing a change in the normal frequency of urination.
In a normally functioning external sphincter muscle, the electromyogram will show increased electrical activity
A diseased external sphincter muscle will produce an abnormal pattern of electrical activity. Conditions that affect the external sphincter may include multiple sclerosis, neurogenic bladder, Parkinson's disease, spinal cord injury, and stress incontinence. However, additional tests must be done in order to confirm any of these diagnoses.
"External Sphincter Electromyography." In Illustrated Guide to Diagnostic Tests, ed. J. A. Lewis. Springhouse, PA: Springhouse Corp. 1994.
Anti-cholinergic drug—A medication that blocks or subdues the action of the neurotransmitter acetylcholine.
Cholinergic drug—A medication that mimics or enhances the action of the neurotransmitter acetylcholine.
Sphincter—A circular muscle that aids in the opening or closing of an opening in the body.