Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence (original) (raw)
Related papers
Is Digital Rectal Exam Reliable in Grading Anal Sphincter Defects?
Arquivos de Gastroenterologia, 2016
Background Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from extensive cases as depicted on 3D endoanal ultrasound, using a scoring sphincter defect and correlate anal tone to anal pressures. Methods Women with fecal incontinence were divided into two groups: small or extensive defects according to the ultrasound scoring system. Sensitivity, specificity, positive and negative predictive values of digital rectal examination in grading global and external sphincter defects were calculated. Anal tone at digital rectal examination was compared to resting and incremental pressures. Results A cohort of 76 consecutive incontinent women were enrolled. The median ...
Anatomic and physiologic measurements of the internal and external anal sphincters in normal females
Obstetrics and gynecology, 1998
To assess the correlation between anal sphincter magnetic resonance imaging (MRI) measurements and manometric anorectal vectography pressures. Ten healthy, nulliparous women underwent anal sphincter MRI with examination of sagittal, axial oblique, and coronal planes. Anal manometry was performed with a radial eight-channel catheter. Customary functional measurements were recorded, including anterior and posterior sphincter length, squeeze length, length of the high-pressure zone, and maximal resting and squeeze pressures. The Spearman rank correlation coefficient was used to assess correlation. The manometric squeeze length and the manometric length to maximum squeeze pressure were correlated negatively with the posterior sphincter length by MRI (P = .049 and .044, respectively). The manometric high-pressure zone squeeze length was correlated positively with the posterior sphincter length by MRI (P = .042). The mean +/- standard deviation (SD) posterior sphincter length was 27.3 +/-...
Surgical Endoscopy, 2004
Background: Perineal body thickness (PBT) is measured by endoanal ultrasonography. The literature has shown that women with obstetric trauma to the anal sphincter have decreased PBT, and a measurement of 10 mm or less has been proposed as abnormal. Therefore, this study aimed to compare the proposed definitions of normal to pathologic findings in patients with fecal incontinence (FI) and to correlate PBT with anorectal physiologic findings. Methods: All female patients who had endoanal ultrasonography and PBT measurement for evaluation of FI were assessed and divided into three groups on the basis of PBT: 10 mm or less, 10 to 12 mm, more than 12 mm. The degree of FI (0 = complete continence; 20 = complete incontinence) was correlated with PBT. Results: For this study, 83 female patients with a mean age of 59.7 years (range, 30-88 years) had endoanal ultrasonography and PBT measurement. Sphincter defects were suggested by endoanal ultrasonography in 77% of the patients in the three groups as follows: 57 (97%) of 59 patients, 4 (36%) of 11 patients, and 3 (23%) of 13 patients. The mean external sphincter defect angle was 110°(range, 45-170°), and the mean FI score was 13.8. For 89% of the patients there was a history of vaginal delivery. As reported, 35% had undergone one or more prior perineal surgeries, 27% had both, and 4% denied having had either. A significant correlation between sphincter defect and PBT (p < 0.001) was noted. External sphincter defect angles were negatively correlated with PBT (p = 0.001). Conclusion: A PBT of 10 mm or less is considered abnormal, whereas a PBT of 10 mm to 12 mm is associated with sphincter defect in one-third of patients with FI. Those with a PBT of 12 mm or more are unlikely to harbor a defect unless they previously have undergone reconstructive perineal surgery.
International Journal of Colorectal Disease, 1993
To determine the clinical value of anorectal physiology testing, we have assessed 73 patients with neurogenic incontinence (median age 55 years, 60 female) and 115 controls (median age 48 years, 81 female). All the faecally incontinent patients displayed abnormal anal mucosal electrosensitivity and prolonged pudendal nerve latencies. Rectal compliance was poor in 14% of patients with neurogenic incontinence. Twenty-seven sphincter injuries were identified by endoanal ultrasonography in patients with neurogenic incontinence. Anal sphincter dectromyographic abnormalities were demonstrated in all the incontinent patients. Anal pressures were lower in the incontinent group. Frequent, abnormal internal sphincter relaxations were observed in patients with incontinence during ambulatory assessment. These tests provide objective evidence of injury but do not frequently affect clinical decision making. Endoanal ultrasonography and ambulatory assessment provided clinical information of the mechanism of incontinence in 60% of patients.
Fatigability of the external anal sphincter in anal incontinence
Diseases of the colon & …, 2004
INTRODUCTION: Anal incontinence commonly results from external anal sphincter dysfunction. The muscle is routinely assessed by anorectal physiology studies. Fatigability is not routinely measured but should be an important factor in the maintenance of continence. The fatigue rate index has been developed to address this. The purpose of this study was to investigate the fatigability of the external anal sphincter in incontinent patients compared with that in controls and to determine its correlation with symptom severity and pudendal nerve terminal motor latency measurement. METHODS: Forty-two patients with anal incontinence (33 female, 9 male) and 20 control patients (17 female, 3 male) were studied. As part of anorectal physiology studies, manometry was measured by a station pull-through technique with a closed-system microballoon. After a rest period of one minute, fatigue was measured over a 20-second squeeze at 1.5 cm in the anal canal with two consecutive readings separated by a further one-minute rest period. The fatigue rate index was calculated from the maximum squeeze pressure and fatigue rate. A validated symptom severity scoring system was used to assess symptomatology in patients with anal incontinence. RESULTS: No difference was detected in demographic factors between the two groups. The fatigue rate index was significantly different between the control and incontinent groups (1.85 vs. 0.67 minutes, P = 0.001). No other factors were significantly different between the two groups (maximum squeeze pressure, 89.1 vs. 79 cm H(2)O, P = 0.42; fatigue rate, -85.8 vs. -101.2 cm H(2)O/min, P = 0.62). The fatigue rate index demonstrated a significant correlation with symptom score ( r = -0.44, P = 0.005). The fatigue rate index did not correlate with latency measurement. CONCLUSIONS: A significant difference was detected in the fatigue rate index between incontinent and control patients. The Fatigue Rate Index demonstrated a significant correlation with symptom severity score and it may be a useful discriminating measure of external anal sphincter function.
Surgery, 2016
Background. The physiologic assessment of anal sphincters in cases of posttraumatic fecal incontinence is a fundamental step in planning operative treatment. In this study, we evaluate the correlation between size of anal sphincter defect, anal pressures, and clinical symptoms in patients with posttraumatic fecal incontinence. We also investigate the impact of patients' age, sex, and type of trauma on this correlation. Methods. Records of 70 patients fitting the study's eligibility criteria were collected retrospectively from the archives of Mansoura University Hospitals' colorectal surgery unit. Demographic data of patients, causes of fecal incontinence, images of sphincter defects on endorectal ultrasonography, anal resting and squeeze pressures, and Wexner continence scores were collected, and correlation analysis was performed. Results. Seventy patients (54 males and 16 females) with a mean (±standard deviation) age of 36 ± 16 years were studied. Mean maximal resting anal pressure was 42 ± 16 mm Hg, and mean maximal squeeze anal pressure was 80 ± 35 mm Hg. Size of external anal sphincter defect was negatively correlated with mean maximal squeeze (r = À0.4298). Mean Wexner continence score was correlated positively with size of external anal sphincter defect (r = 0.3743). Both correlations became significantly stronger in female patients, patients greater than 50 years, postfistulectomy patients, and patients with obstetric injuries. Conclusion. Size of external anal sphincter defect correlates negatively with mean maximal squeeze and positively with symptoms score. This correlation is stronger in females, patients greater than 50 years, and patients with postfistulectomy or obstetric injuries. These findings suggest that this group of patients requires additional assessment before surgical repair.
International Urogynecology Journal, 2020
Introduction and hypothesis Our aim was to explore the association between anal incontinence (AI) and persistent anal sphincter defects diagnosed with 3D endoanal (EAUS), introital (IUS) and transperineal ultrasound (TPUS) in women after obstetric anal sphincter injury (OASI) and study the association between sphincter defects and anal pressure. Methods We carried out a cross-sectional study of 250 women with OASI recruited during the period 2013–2015. They were examined 6–12 weeks postpartum or in a subsequent pregnancy with 3D EAUS, IUS and TPUS and measurement of anal pressure. Prevalence of urgency/solid/liquid AI or flatal AI and anal pressure were compared in women with a defect and those with an intact sphincter (diagnosed off-line) using Chi-squared and Mann–Whitney U test. Results At a mean of 23.6 (SD 30.1) months after OASI, more women with defect than those with intact sphincters on EAUS had AI; urgency/solid/liquid AI vs external defect: 36% vs 13% and flatal AI vs inte...