{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:59:19Z","timestamp":1782313159105,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,8,29]],"date-time":"2006-08-29T00:00:00Z","timestamp":1156809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2007,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Functional asymmetry of pelvic floor innervation has been shown to exist in healthy subjects, and has been proposed to be a predictor of increased risk for fecal incontinence in case of trauma. However, this remains to be shown for different clinical conditions such as traumatic childbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A conventional surface EMG system was used to assess the innervation of the external anal sphincter. A symmetry index was used to define the relative EMG amplitude asymmetry of the external anal sphincter between 0 (symmetric) and 1 (asymmetric). Three cohorts were studied: 40 nulliparous women in the third trimester (Study 1), 15 primiparous women within 6 months following vaginal delivery without clinically apparent anal sphincter trauma (Study 2), and 50 women after childbirth\u2010related third or fourth degree perineal tear 6\u201312 months postpartum (Study 3). Furthermore, all women underwent conventional anorectal manometry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen or forty nulliparous women reported signs of fecal incontinence; however, relative asymmetry was not correlated to symptom severity (<jats:italic>P<\/jats:italic>\u2009=\u20090.345), and not to manometric measures (Study 1). In Study 2, Women who had suffered clinically apparent anal sphincter trauma (<jats:italic>P<\/jats:italic>\u2009=\u20090.07) tended to have a stronger association between incontinence and asymmetry. In Study 3, 19\/50 women reported moderate to severe incontinence. Asymmetry and symptom severity were significantly correlated (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Patients with incontinence had a significantly higher asymmetry score than their continent counterparts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Functional asymmetry of anal sphincter innervation is significantly associated with incontinence symptoms, but only after childbirth\u2010related sphincter injuries and therefore, should be regarded as an additional risk factor. Neurourol. Urodynam. \u00a9 2006 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.20307","type":"journal-article","created":{"date-parts":[[2006,8,29]],"date-time":"2006-08-29T18:32:31Z","timestamp":1156876351000},"page":"134-139","source":"Crossref","is-referenced-by-count":22,"title":["Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth"],"prefix":"10.1002","volume":"26","author":[{"given":"Beate M.","family":"Wietek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidemarie","family":"Hinninghofen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehard C.","family":"Jehle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Enck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiko 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