Anal sphincter rupture and transanal ultrasound grade correlated with each other ( rs= 0.427, P= 0.001). Both rupture and transanal ultrasound grade correlated with soiling grade ( rs= 0.2, P= 0.03 for both), but in a multiple regression analysis, only transanal ultrasound grade was significant ( P= 0.001) as an independent variable. Anal incontinence score correlated with all the manometry variables, but in a multiple regression analysis, only squeeze pressure was significant ( P= 0.001, beta = -0.4) as an independent variable. Both anal sphincter rupture and transanal ultrasound grade were correlated with manometry variables, but only transanal ultrasound grade was significant as an independent variable after multiple regression analysis. The frequency of transanal ultrasound-verified extensive defect of anal sphincter was higher in rupture Grade 3B (25; 95 percent confidence interval, 12-38 percent) and Grade 4 (45; 95 percent confidence interval, 24-66 percent) than in Grade 3A (2.8; 95 percent confidence interval, -1 to -6.6 percent).(s) (s)CONCLUSION Manometry variables are significantly lower in incontinent females than in continent females, and the Wexner incontinence score was correlated with manometry variables. Both anal sphincter rupture and transanal ultrasound grade correlated with soiling grade and with manometry variables, but in both cases only the transanal ultrasound grade was a significant independent variable.

Background. The aim of this study was to determine whether there exists a correlation between anal incontinence, occult sphincter injuries, anal manometry values, and delivery variables in primiparous women after first time vaginal delivery. Methods. Eighty-six primigravida women were recruited for this study. Transanal ultrasonography (TAUS) and vector volume manometry (VVM) was performed and bowel symptoms were recorded at 25 weeks of pregnancy and 5 months after labor. Incontinent women at 5 months after vaginal delivery were interviewed again at 12 months. Results. Nineteen women (25%) experienced flatus incontinence postpartum. After 12 months, only one-third of the women were still incontinent. Fourteen women (19%) showed abnormal TAUS of the anal sphincter. Of the delivery variables, only baby head circumference was significantly associated with flatus incontinence (p Ω 0.01). There was no correlation between flatus incontinence or delivery variables and anal sphincter injuries; VVM values were not associated with either anal sphincter injuries or flatus incontinence at 5 months, but VVM values were negatively associated with flatus incontinence at 12 months after labor. Conclusions. At 5 months after labor, flatus incontinence is relatively common, and is not associated with reduced VVM values. Two-thirds of women recover from flatus incontinence during the first year. Women who had flatus incontinence persisting for a minimum of 1 year had reduced VVM values. Anal sphincter injuries as seen by TAUS are not associated with either VVM values or any delivery variable. Baby head circumference is the only delivery variable significantly associated with flatus incontinence.

Fecal incontinence symptoms worsen with increased follow-up time, and the change in working status is the most likely explanation; therefore, early evaluation of bowel symptoms is misleading. Denervation injury of the anal sphincter is an independent risk factor for anal incontinence but has no association with urinary incontinence. Urinary urgency and stress incontinence symptoms are strongly associated with fecal urgency.

Results of this study show for the first time that the claims substantiated with references in the pharmaceutical advertisements in Pakistan are highly unreliable.