Chapter 1 24 When finishing the digital rectal exam, it is important to inspect the finger for obvious blood, mucus or pus and note the color of the feces. Gaping of the anal canal is suggestive of a neurological or sphincter defect.55 Surface electromyography (s-EMG) Pelvic floor muscle tone and function could also be measured with surface electromyography (s-EMG) (μV),49 with intravaginal or-anal probes.56,57 s-EMG is the only tool that can directly assess the pelvic floor muscle activity by measuring electrical signals which is generated along muscle fibers after depolarization of their motor nerve.58 s-EMG is used to evaluate motor control patterns, coordination and location of the pelvic floor muscles and gives the practioner and patient information about the ability to contract and relax and whether there is an increase or decrease in activity during a particular task.59 The use of down training, has been proven effective in creating awareness to avoid holding tension.57,60 A validated EMG electrode, the Multiple Array Probe (MAPLe®), was used in the present study. The MAPLe® probe uses a unipolar configuration, a validated location, is not sensitive for crosstalk and is capable of registering EMG-activity on all sides and depths of the pelvic floor during diagnosis and treatment.61 Biofeedback MAPLe®
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