Investigation of fecal incontinence with endoanal ultrasound

Rieger, Nicholas; Sweeney, James L.; Hoffmann, D. C.; Young, James F.; Hunter, Andrew

doi:10.1007/bf02053983

Cited by 42 publications

(16 citation statements)

References 17 publications

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“…The prevalence of EUS-identified anal sphincter defects in patients with incontinence ranges from 28-80% (5,16). The most common cause of sphincter injury is obstetrical trauma, which is often occult (3).…”

Section: Discussionmentioning

confidence: 99%

Endoanal Ultrasound Compared to Anorectal Manometry for the Evaluation of Fecal Incontinence: A Study of the Effect These Tests Have on Clinical Outcome

et al. 2006

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Tests for evaluating incontinence include endoanal ultrasound (EUS) and anorectal manometry. We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients. The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence. Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter (IAS) and external anal sphincter (EAS). EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test. Anorectal manometry was performed with a standard water-perfused catheter system. A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test. All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up. Improvement in fecal control was defined as a 25% or greater decrease in continence score. EUS versus manometry were compared with subsequent surgical treatment and outcome. P-values were calculated using Fisher's exact test. Patients (n = 32; 31 females) were followed for a mean 25 months (range 13-46). Sixteen patients had improved symptoms (50%). There was no correlation between EUS or anorectal manometry sphincter findings and outcome. Seven of 14 (50%) patients who subsequently underwent surgery versus 9 of 18 (50%) without surgery improved (P = .578). In long-term follow-up, approximately half of patients improve regardless of the results of EUS or anorectal manometry, or whether surgery is performed.

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Section: Discussionmentioning

confidence: 99%

Endoanal Ultrasound Compared to Anorectal Manometry for the Evaluation of Fecal Incontinence: A Study of the Effect These Tests Have on Clinical Outcome

et al. 2006

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“…1). Birth-related anoperineal tears are classified on a clinical basis and scored from 0 to 4 as follows: grade 0 corresponds to an intact perineum; a first-degree tear is the involvement of the vaginal mucosa and skin; in a second-degree tear the perineal body is also involved; the third-degree tear is divided into three types (type a, when less than 50% of the thickness of the EAS is damaged; type b, when more than 50% of the thickness of the EAS is disrupted; and type c, when the IAS is also involved); in the fourth-degree tear, the lesion is extended to the anal mucosa [9][10][11]. Ultrasonography is used to confirm the diagnosis in third-and fourth-degree tears.…”

Section: Resultsmentioning

confidence: 99%

“…Since its introduction in 1989 [1][2][3][4][5], anal endosonography (AES) has become an essential part of the pre-operative diagnostic work up in many anal diseases such as fistulae [6,7], sphincter defects [8][9][10][11] and anorectal tumours [12][13][14][15][16][17]. For anal fistulae, in particular, AES has been favourably compared with more expensive techniques such as magnetic resonance imaging (MRI) [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Anal endosonography: a survey of equipment, technique and diagnostic criteria adopted in nine Italian centers

et al. 2007

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“…Ultrasound is of limited value in the investigation of the neuropathic anal sphincter 13 . Defects seen on anal ultrasound have been correlated accurately with operative findings 14−17 .…”

Section: Faecal Incontinencementioning

confidence: 98%

Endoanal and endorectal ultrasound: applications in colorectal surgery

Rieger¹,

Tjandra²,

Solomon³

2004

ANZ Journal of Surgery

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Endoanal and endorectal ultrasound have an important role in colorectal surgery. They can be applied in the management of faecal incontinence, rectal tumours and inflammatory perianal conditions. In faecal incontinence, anal ultrasound will confirm the presence or absence of sphincter defects. This will direct any operative intervention such as direct sphincter repair. Ultrasound in rectal cancer allows staging of the tumour by assessing the depth of invasion through the bowel wall and involvement of mesenteric nodes. Such staging might influence the choice of operation and determine which patients might benefit from preoperative chemotherapy and radiotherapy. Ultrasound has a particular role in recurrent and complex anal fistula and perianal sepsis. Preoperative and perioperative planning with accurate delineation of fistula tracts, extensions and sphincter involvement might help prevent recurrence and impaired continence from sphincter damage after surgery. Correct interpretation of ultrasound images requires training and experience so that the results can be properly correlated with the clinical situation.

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Investigation of fecal incontinence with endoanal ultrasound

Abstract: Sphincter defects seen on ultrasound may not have a history of obstetric trauma or abnormal clinical and manometric findings. Endoanal ultrasound is recommended in all patients with fecal incontinence to detect occult sphincter defects.

Cited by 42 publications

References 17 publications

Endoanal Ultrasound Compared to Anorectal Manometry for the Evaluation of Fecal Incontinence: A Study of the Effect These Tests Have on Clinical Outcome

Endoanal Ultrasound Compared to Anorectal Manometry for the Evaluation of Fecal Incontinence: A Study of the Effect These Tests Have on Clinical Outcome

Anal endosonography: a survey of equipment, technique and diagnostic criteria adopted in nine Italian centers

Endoanal and endorectal ultrasound: applications in colorectal surgery

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