Standardisation of anal sphincter EMG: high and low threshold motor units

Objective: The anal sphincter muscle has a proportion of low threshold motor units (MUs) that are continuously active and other, recruitable high threshold MUs. In standard EMG recordings, motor unit potentials (MUPs) of the later seem to be of higher amplitudes. A quantitative EMG study was performed to assess possible consequences of sampling MUPs at different levels of sphincter activation. Methods: Fifteen females without uroneurological disorders were studied. After insertion, standard concentric EMG needle was left in the anal sphincter muscle undisturbed for 1 min; then 30 s of the remaining continuous, and 1 min of voluntarily increased EMG activity were recorded on a DAT recorder. MUPs were collected and analysed by ‘Multi-MUP’ analysis. MUPs analysed during relaxation constituted the ‘low threshold MUP pool’. MUPs sampled on activation were checked for those, already sampled during relaxation, (which were discarded), and the remaining MUPs constituted the ‘high threshold MUP pool’. Parameters of both MUP pools were compared. Results: High threshold MUPs were found to be significantly larger than low threshold MUPs. Conclusions: EMG investigator should be aware of the differences of MUPs sampled at various anal sphincter activity levels. For the technique of ‘Multi-MUP’ analysis sampling at an activity level which provides 3–5 MUPs per detection site would seem practical, providing a standardised approach suitable for comparing normative data with individual findings from most patients.