Weak Anal Wink Reflex ?

this is embarressing, but recently I ordered copies of all my medical records. I had an exam with my ob/gyn because my GP told me to have an exam by him because I was having incontinence again (after a major surgery to fix those roblems) and anyway, he noted in his exam that I had a "very weak anal wink reflex". What exactly does that mean and how the heck did that happen? I read some info on the net last nite and it could be related to my lumbar back issues OR it could be a nervous system issue. I'd bet also that's why I developed prolapse, a rectocele and enterocele and had to have it all fixed with major surgery - yet I still have urinary problems.

I will definately be sure to bring this up to my neuro at our 1st appt. on next Wed.   Do any of you know during a full first neuro examination, do they check these types of reflexes as well?  Thanks.

[Caliber2005]

Hi spanky,
How are you feeling now?
The anal wink, anal reflex, perineal reflex, or anocutaneous reflex is the reflexive contraction of the external anal sphincter upon stroking of the skin around the anus. The stimuli is detected by the nociceptors in the perineal skin to the pudendal nerve, where a response is integrated by the spinal cord sacral segments S1-S3.The absence of this reflex indicates that there is an interruption of the reflex arc, which may be in the sensory afferent limb or the motor efferent limb. The synapse between the afferent and efferent limbs occurs in the lowest sacral segments of the spinal cord.
May be its post-surgery nerve disturbance would have done this.
I suggest you see a neurologist at earliest.
Well it is difficult to tell, as there are other reflexes to evaluate.

[spankyandrex]

Yes, my 1st neuro appt. is next Wed the 5th.  It could be surgery related, I suppose, but he never told me I would have reduced reflex down there and theonly time I ever had a bowel incontinence problem (happened only 1x) was 2 years before my surgery.  I'd bet it's definately my spine.  Thanks for the info, very informative.  I am a mess with my nerves, I tell ya.

[sonu78]

Hi,
How do u feel.
A rectocoele or an enterocoele is the prolapse of rectum or bowel through  some weak spot either through the vaginal wall in case of females, through abdominal wall (enterocoele), or an rectal prolapse.
An neurological evaluation is most essential at this stage.
Kindly post the neurologist advice.

[Godofredo MD]

Hi.

How old are you now? Have you given birth before? If yes, how many times? What were the surgeries performed on you? What type of incontinence are you experiencing?

Pelvic organ prolapse is a condition wherein the pelvic floor muscles weaken or become damaged and can no longer support the pelvic organs. A rectocele and enterocele are related to prolapse of the posterior vaginal wall.

The anal wink reflex, or perineal reflex, is related to anal sphincter injury. According to a study published in the journal Obstetrics & Gynecology, anal sphincter disruption is common in women with pelvic floor disorders and likely plays a significant role in the development of anal incontinence in this population. While a neurological condition may cause weakness of the perineal reflex, it is more likely related to anatomical anal sphincter injury.

You could still opt to consult a neurologist and undergo a complete neurological examination to rule out any underlying neurologic disorder.

Good luck.

[spankyandrex]

I am 38 years old. I had the surgery in 2/06.  One birth - I gave birth to a 5lb. 13 oz. boy on 3/17/02.  He was small and I had a vaginal birth with no complications, in fact very easy.  This is what I had done.  It was called a Burch Retropubic Urethropexy, enterocele and rectocele all repaired with Apogee Mesh.  A/P Vaginal Repairs and a Tubal Ligation.  It was an abdominal incision and I also had two incisions on my butt cheeks.   Intercourse, is still painful for me, but not ALL the time.   If it matters, I am 5'8" tall and weigh 195. A bit overweight, I know.

Before this surgery, I was experiencing stress incontinence - laughing/sneezing/coughing/and heavy work made me leak.

NOW, not stress, just leaks out when I'm doing daily activities such as walking/sitting/ etc.  It leaks more when I am doing more strenous work like vacuuming (yay, real strenuous), mopping the floors or lifting boxes or moving furniture.  The Dr. that did my surgery is a uro/gynecologist.  The letters after his name are D.O.  He said he's done lots of these surgeries.  

Thank you very much.

[spankyandrex]

Can you respond to my answers to your questions please?  Thank you so much for being here today it is MUCH aprpeciated.

[Godofredo MD]

Hi.

It seems the surgery was indeed done to address your stress incontinence. However, there are rare times when the this type of surgery does not produce a favorable result, with consequent persistence of symptoms.

You mentioned lumbar back problems before. Has an MRI been done to check your spine? If a spine problem is present, there is a possibility that it might be related to the incontinence.

In any case, it would probably be advisable to consult a neurologist as soon as possible to offer any insight on your symptoms.

Good luck.

[spankyandrex]

THANK YOU, yes, had 2 lumbar MRI's.  Have Facet Arthropathy, and bulging disks, that was 2 years ago.  I have a neuro consult on 12/5, next Wed.  THANKS again.