Wyndaele et al developed a three part test for muscles of the male pelvic floor during a digital rectal examination. This can help identify patients with weak pelvic floor muscles for whom strengthening exercises might be helpful. The authors are form the University of Antwerp in Belgium.
Problems which may be related to weak pelvic floor muscles:
(1) urinary incontinence
(2) dysuria
(3) fecal incontinence
(4) constipation
(5) sexual impotence
(6) ejaculation problems
Patients at risk: This was not stated. I would imagine a person with a history of trauma might be a candidate. Long term bicycle riders might form another population at risk.
Muscles tested:
(1) bulbocavernous: 2 fingers are placed beneath the scrotum, in the midline, ventral to the centrum tendineum perinei.
(2) external anal sphincter: The distal phalanx of the index finger is placed in the anal meatus.
(3) puborectalis muscle: The 2 phalanges of the index finger are in the anal canal and directed laterally-dorsally.
Parameters:
(1) muscle strength
(2) endurance
(3) exhaustion
|
Parameter
|
Finding
|
Points
|
|
muscle strength
|
no contraction; muscle silent
|
0
|
|
|
flicker of contraction; no squeeze
|
1
|
|
|
muscular tension; a weak squeeze; no displacement
|
2
|
|
|
muscular contraction; a fair squeeze with definite lift; displacement present
|
3
|
|
|
muscular contraction against moderate resistance; a good squeeze; good hold with lift
|
4
|
|
|
muscular contraction against maximal resistance; a strong squeeze with a good lift
|
5
|
|
endurance
|
(number of seconds able to hold maximal muscular contraction)
|
MIN (5, seconds)
|
|
exhaustion
|
(number of repeats with maximal strength and endurance)
|
MIN (5, number)
|
after Table 1, page 1180
where:
• Displacement during muscle strength testing indicates an upward, inward lifting.
• The rest period during exhaustion testing is 2 times the endurance time, up to 10 seconds.
• Exhaustion is indicated by a drop in either the strength or endurance.
Limitations:
• The testing requires a cooperative patient and an experienced tester.
