COUGH ANAL REFLEX: STRICT RELATIONSHIP BETWEEN INTRAVESICAL PRESSURE AND PELVIC FLOOR MUSCLE ELECTROMYOGRAPHIC ACTIVITY DURING COUGH. URODYNAMIC AND ELECTROPHYSIOLOGICAL STUDY

ABSTRACTPurpose: Cough and more generally abdominal strain determine a pelvic floor contraction which allows an increase in sphincter pressure to prevent leakage during stress. Many electrophysiological studies have demonstrated this reflex (formally cough anal reflex). We postulated that the perineal muscle contraction following cough is not a simple binary response but proportional to the intensity of the cough.Materials and Methods: A total of 16 women (mean age 52 years) without neurological disease or stress urinary incontinence, referred for frequency and urgency without urge incontinence, underwent urodynamic investigation. Vesical pressure was compared to electromyographic activity of the anal sphincter during 4 successive coughs of different intensity, namely gentle, moderate, strong and very strong efforts. These 4 graded coughs were repeated at 0, 100, 200, 300 and 400 ml of filling during cystometry.Results: All patients were able to determine a graded cough at each level of filling. In all pa...