Anal Sphincter Defect and Fecal Incontinence

Abstract

Anal sphincter defects can lead to fecal incontinence. The relationship between the extent of defect and continence is controversial. Magnetic resonance imaging (MRI) of the pelvis can assess anal sphincter defects. Transrectal ultrasonography (TRUS) is used to assess sphincter integrity in adults. We present a 17-year-old male with history of sexual abuse, rectal prolapse, and fecal incontinence. MRI showed a small defect that did not explain his clinical presentation. TRUS identified more extensive defects which were not picked up by MRI. The patient had rectopexy, and his rectal prolapse and fecal incontinence resolved. TRUS was superior in identifying sphincter defects compared with MRI. Our case also highlights that continence is possible despite large sphincter defects in pediatric patients. This may reflect the compensatory mechanism of residual sphincter in the absence of the aggravating factors like rectal prolapse.

Clinical Application Of Endoanal And Endorectal Ultrasound For Benign And Malignant Conditions Of The Anus, Perianal Space, And Rectum

“…It is described as "inability to defer the release of gas or stool from the anus and rectum by mechanisms of voluntary control" (20). Common causes include traumatic sphincter defects (e.g., childbirth in women), rectal prolapse, anorectal malformations, complications after surgery for Hirschsprung's disease, and others (1,20,21). Transrectal US is capable of assessing the sphincter integrity in adults and diagnosing sphincter disruption in approximately 95% of cases (Fig.…”

“…Transrectal US is capable of assessing the sphincter integrity in adults and diagnosing sphincter disruption in approximately 95% of cases (Fig. 5) (21).…”