Male, 46 years, has anal pain and difficulty emptying the bowel


Man, 46 years old, a sedentary occupation, suffers from anal pain especially during defecation, with pain that continues for a long period thereafter. Evacuation is laborious during defecation and he strains a lot throughout the day. He feels as if there is an obstruction and cannot fully empty his bowels.

In addition, he sometimes experiences painful ejaculation as well as premature ejaculation and occasional dysfunctional voiding.

The rubber band ligation procedure for haemorrhoids was performed on a number of occasions. The patient is now suffering from anal fissures for which he is using diltiazem cream.

A reading was taken by the MAPLe following an internal examination. See photo below.

Image 1: Diagnosis using the MAPLe

Afbeelding casus Jenneke

This is a resting measurement. Excessive muscle tension can be seen here, specifically in the sphincter complex and most likely in the autonomous part of the external sphincter too (Pennincks 2013, Broens 2013).

The treatment
The patient is made aware of the pelvic floor through breathing exercises and remedial therapy with the emphasis on relaxation. This is achieved with supporting biofeedback using the MAPLe.

Electrostimulation is also used with the MAPLe for further awareness and to improve the coordination of the various muscle groups. In addition, ES is used to bring about better relaxation.

The patient is then taught the correct pushing technique. This is practised and monitored using the MAPLe in a seated position.

The treatment is concluded with balloon expulsion-training.

The result
The patient is no longer experiencing any pain when defecating and the anal fissures are healing better. Improved emptying, now once a day. He no longer needs to strain. He suffers less from premature ejaculation, has no more pain during ejaculation and has had no further dysfunctional voiding.

Below resting measurement with the MAPLe shows that pelvic floor function has been restored. The muscle activity has fallen from 14.0 µV to 3.6 µV.

Image 2: Resting measurement using the MAPLe

Afbeelding casus Jenneke 2

In addition, it is clear to see with the MAPLe that the patient has now adopted the correct pushing technique. The circle is a nice light grey with an average activity of 1.9 µV when pushing. See photo below:

Image 3: The result

 Afbeelding casus Jenneke 3

Thanks to the MAPLe a good understanding of the patient’s pelvic floor behaviour has been achieved on various levels. Where there is extreme, high intensity of stress that cannot be influenced (autonomous part of the sphincter), targeted applications of Botox can be used at a specific level which is determined by the MAPLe.

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