Investigations of Anorectal Function

Scott, S. M.; Lunniss, Peter J.

doi:10.1007/978-1-84628-503-5_9

Cited by 5 publications

(5 citation statements)

References 129 publications

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“…This may be due to the fact that the aetiology of AI is multifactorial and our questionnaire constructed for evaluation of AI did not include questions on potential risk factors described in the literature, such as diabetes, previous anorectal surgery or cholecystectomy. 11 , 22…”

Section: Discussionmentioning

confidence: 99%

Anal and urinary incontinence in nulliparous women – Prevalence and associated risk factors

et al. 2021

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Objective To establish the prevalence and risk factors of urinary and anal incontinence in nulliparous women. Study design Thirty-one catholic convents were sent a validated questionnaire to determine the prevalence and severity of urinary incontinence, and a similarly structured questionnaire to assess anal incontinence. Multivariable regression models were used to determine independent risk factors associated with the likelihood of urinary incontinence or anal incontinence. Main outcome measures Urine/faecal/flatal incontinence and symptom severity. Results Of 202 nuns, 167 (83%) returned the questionnaire. Twenty-two women were excluded due to history of childbirth. Of 145 nulliparous women, 56.2% reported urinary incontinence and 53.8% reported anal incontinence. Women aged 66–76 years had significantly increased odds of experiencing urinary incontinence in comparison to women aged 40–65 years: OR: 2.35 (95% CI: 1.02–5.45) ( p = 0.04). The risk of urinary incontinence was increased in women with a body mass index ≥ 30 in comparison to those with a body mass index < 19: OR: 6.25 (95% CI: 1.03–38.08) ( p = 0.04). With regards to anal incontinence, although none of the differences with age and body mass index groups reached statistical significance, there was a trend towards women in higher body mass index groups having an increased prevalence of anal incontinence. Current/previous hormonal replacement therapy was also associated with significantly increased odds of experiencing urinary incontinence: OR: 2.53 (95% CI: 1.01–6.36), ( p = 0.04). However, when adjusting for age and body mass index, there was no significant association with urinary incontinence. Conclusions This study highlights that while childbirth is an important risk factor, urinary incontinence and anal incontinence also occur in over 50% of nulliparous women. Additional studies are required to identify other risk factors that may be associated with incontinence in this population.

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Section: Discussionmentioning

confidence: 99%

Anal and urinary incontinence in nulliparous women – Prevalence and associated risk factors

et al. 2021

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“…In addition, like anal incontinence, wound complications can have a negative psychological and emotional impact on women 3,4 . Although anal incontinence is multifactorial in etiology, the integrity of the anal sphincter is important in maintaining continence 5 . However, despite primary repair, approximately 60% of women will have a persistent anal sphincter defect diagnosed on ultrasound and 39% will experience anal incontinence 1,6 .…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Although anal incontinence is multifactorial in etiology, the integrity of the anal sphincter is important in maintaining continence. 5 However, despite primary repair, approximately 60% of women will have a persistent anal sphincter defect diagnosed on ultrasound and 39% will experience anal incontinence. 1,6 Wound infection can be superficial but can also extend to disrupt tissue and fascia at a deep and organ space level.…”

Section: Introductionmentioning

confidence: 99%

Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study

Okeahialam

Thakar

Sultan

2023

Acta Obstet Gynecol Scand

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Introduction: Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS). Material and methods: Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT 04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter.Results: Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity.

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“…This is because it is difficult to decipher whether defects ≤ 30° are secondary to a scar formed as part of the normal healing process following surgical repair or due to a defect secondary to the sphincter muscles being unopposed 8 . In addition, the function of the sphincter muscle, which can be demonstrated using anal manometry 9 , has been shown to be significantly worse 10 in women with an anal sphincter defect > 30° in comparison to those with a defect of ≤ 30°. However, defects less than 30° are considered significant if anal manometry pressures are substantially reduced, indicating compromised function 8 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of diagnostic criteria for significant anal sphincter defects between endoanal and transperineal ultrasound

Okeahialam

Thakar

Sultan

2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?Transperineal ultrasound (TPUS) had excellent agreement with endoanal ultrasound in diagnosing the presence of anal sphincter defects. However, there was poor-to-moderate agreement between the two modalities in the measurement of defect angle, with a standard error of measurement of 16 • and 27 • for external and internal anal sphincter defects, respectively. What are the clinical implications of this work?A cut-off angle of 30 • should not be used for the diagnosis of a significant residual anal sphincter defect on TPUS. Further research is required to determine the cut-off angle for a significant defect on TPUS.

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Investigations of Anorectal Function

Cited by 5 publications

References 129 publications

Anal and urinary incontinence in nulliparous women – Prevalence and associated risk factors

Anal and urinary incontinence in nulliparous women – Prevalence and associated risk factors

Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study

Comparison of diagnostic criteria for significant anal sphincter defects between endoanal and transperineal ultrasound

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