External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty

Briel, J. W.; Stoker, J.; Rociu, Elena; Laméris, Johan S.; Hop, Wim C. J.; Schouten, W. R.

doi:10.1046/j.1365-2168.1999.01244.x

Cited by 126 publications

(84 citation statements)

References 28 publications

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“…One study showed that MRI was less accurate than anal endosonography (93), however, others disagree (89). A major contribution of anal MRI has been the recognition of external sphincter atrophy (94) and how this may adversely affect sphincter repair (95). Atrophy may also be present without pudendal neuropathy (96).…”

Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

286

295

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DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

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Section: Magnetic Resonance Imaging (Mri)mentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

286

295

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“…This type of imaging has re-established the importance of anterior sphincteroplasty in these patients [35,36]. The high-resolution imaging afforded by close field endoanal MRI has also provided quality images of these defects and the expected postoperative appearance following sphincter repair [37][38][39], giving the impression that the amount of EAS atrophy adversely correlates with functional post-surgical outcome [40]. For these views, the technique has been well described.…”

Section: Functional Pelvic Disordersmentioning

confidence: 99%

Magnetic resonance imaging and the coloproctologist

Zbar

2001

Tech Coloproctol

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for the assessment of obstetric sphincter damage and changed our understanding of the natural history of this condition. Moreover, it became a mandatory pre-operative assessment of low rectal cancers whose rostral extent lay within reach of the probe, influencing the utilization of local therapies for cure, neo-adjuvant radiotherapy in particular for improvement in long-term outcome and chemo-radiotherapy for clinical disease down-staging.More recently, magnetic resonance imaging (MRI) both as a surface tool and as an endoluminal tool has developed for specialized usage by the coloproctologist in the assessment of benign and malignant anorectal disease. It has received recent attention as a dynamic modality for the demonstration of specific disorders of the pelvic floor and rectal evacuation although its exact place in pelvic floor dysfunction needs to be determined.This short review assesses the indications and pitfalls of the use of MRI technology in the delineation of anorectal disease and dysfunction. Defining anorectal anatomyThe recent introduction of high-resolution endoluminal MRI appears to have largely settled many of the traditional disputes concerning the anatomy of the internal and external anal sphincters (IAS and EAS) in man. The confusing anatomical studies which divided the sphincter into one [1,2] or two [3,4] components have been replaced by the 3-component model of the EAS as part of the puborectalis complex with a variable constitutive amount of overlap of the end of the IAS [5, 6].This has been confirmed by the coronal views provided by MRI technology (and recently by computer-aided 3-dimensional reconstruction of axial ultrasound images). Variability in main sphincter overlap may be present in different anorectal diseases, perhaps accounting for poor clinical results in those undergoing either internal anal sphincterotomy or anal Tech Coloproctol (2001) 5:1-7Abstract A personal view of the clinical importance and usage of magnetic resonance imaging (MRI) in coloproctology is presented. The real advantage of this modality lies in the assessment of complex recurrent perirectal sepsis. Recent research shows a potential value of dynamic surface MRI in patients with functional disorders of evacuation.

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“…Es konnte auch gezeigt werden, dass Patientinnen mit geburtstraumatischem Sphinkterdefekt und Externusatrophie ein schlechteres funktionelles Ergebnis nach Sphinkterrekonstruktion erzielten als bei normalem Externus [64]. Ultraschall und MRT sind bei der Darstellung der Externusmorphologie äquivalent; der Ultraschall ist aber bei der Diagnose eines Internusschadens überlegen [65], sodass die Modalitäten derzeit als komplementär zu werten sind.…”

Section: Endoanale Magnetresonanztomografieuntersuchungunclassified

Messmethoden zur Diagnose der fäkalen Inkontinenz

2001

Visc Med

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Anorectal Testing Techniques for Fecal Incontinence Anorectal testing techniques for fecal incontinence are used in addition to clinical evaluation. This entails a detailed history, which may be complemented by symptom diaries and self-administered questionnaires, and physical examination. The latter allows for a qualitative assessment of resting tone and squeeze increment, functional anal canal length, perineal descent, perianal sensation, and anocutaneous reflex activity. Anorectal testing techniques for fecal incontinence are presented and assessed for their clinical usefulness. Anorectal manometry in combination with rectal balloon distention tests measures resting tone, voluntary contraction increment, and rectal sensory thresholds. Endoluminal ultrasound has largely replaced EMG mapping for anal sphincter defects, resulting in an increased number of patients amenable to direct surgical repair. Apart from initial diagnosis the described modalities may be used for documentation of any changes over time and during therapy. Tests of nerve and muscle function, and magnetic resonance imaging of the pelvic floor and anal sphincters are currently mainly used for research purposes.

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External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty

Cited by 126 publications

References 28 publications

Diagnosis and Management of Fecal Incontinence

Diagnosis and Management of Fecal Incontinence

Magnetic resonance imaging and the coloproctologist

Messmethoden zur Diagnose der fäkalen Inkontinenz

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