Normal Female Anal Sphincter

Bollard, Ruth; Gardiner, Angela; Lindow, S. W.; Phillips, K.; Duthie, G S

doi:10.1007/s10350-004-6139-7

Cited by 77 publications

(17 citation statements)

References 10 publications

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“…The underlying reason for this is not clear. Some previous studies on normal female subjects did not show any association of IAS length with age and reproductive history[24,25]. However, the situation in CP is unclear.…”

Section: Discussionmentioning

confidence: 86%

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Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

Xue

Ding

et al. 2017

WJG

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AIMTo assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP).METHODSIn this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups.RESULTSPatients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 ± 3.59 mm vs 28.87 ± 4.84 mm, P < 0.05 and 9.67 ± 1.57 mm vs 8.85 ± 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23° ± 1.81° vs 89.94° ± 2.07° in control group, P < 0.05) and straining (88.47° ± 3.32° vs 90.72° ± 1.87° in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23° ± 1.81° vs 88.47° ± 3.32° respectively, P > 0.05).CONCLUSIONThe association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.

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Section: Discussionmentioning

confidence: 86%

“…Several studies have shown that IAS thickness is a more reliable and reproducible parameter than EAS thickness[24]. In addition, we also measured the length of IAS in the posterior portion of the anal canal in the mid-sagittal plane.…”

Section: Discussionmentioning

confidence: 99%

Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

Xue

Ding

et al. 2017

WJG

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“…Methods of documenting and reporting of sphincter abnormalities vary in the literature. Some studies record endoanal images at 1 cm levels from the anal verge, 6 while others report the presence of defects in the IAS and EAS within quadrants 13 . Sultan et al .…”

Section: Discussionmentioning

confidence: 99%

“…The mid level of Liverpool Ultrasound Pictorial Chart (LUPIC) is defined as the point at which the EAS joins anteriorly to form a complete ring. As described by Bollard et al , 6 a natural gap or defect occurs in the anterior EAS of many female patients below the level of the puborectalis sling. The exact distance from the anal verge to the LUPIC mid level will therefore vary with this known natural variation in length of the anterior EAS.…”

Section: Methodsmentioning

confidence: 99%

“…To date, there is no published standardised method of documenting sphincter injury diagnosed by endoanal ultrasound. Some clinicians report views at three to four different levels, 13,14 while others record findings at centimetre measurements from the anal verge 6,15 . Such inconsistent reporting of ultrasound findings makes any comparison between different clinicians or patient groups very difficult.…”

Section: Introductionmentioning

confidence: 99%

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Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound

Fowler

Adams

Bolderson

et al. 2008

BJOG

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Objective To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter.Design A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed.Methods To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans.Main outcome measures Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A-E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations.Conclusions LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms.

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Normal Values of Anal Sphincter Biometry by 4‐Dimensional Translabial Ultrasound: A Retrospective Study of Pregnant Women in Their Third Trimester

Mendoza

Fatakia

Atan

et al. 2019

J of Ultrasound Medicine

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Objectives-Exoanal 4-dimensional translabial ultrasound (TLUS) is increasingly used to image the anal sphincter. The aim of this study was to define the limits of normality for assessment of external and internal anal sphincters with TLUS.Methods-This study was a retrospective analysis using data sets of nulliparous women seen antenatally. All women had a 4-dimensional TLUS examination at a mean gestational age AE SD of 36 AE 0.7 (range, 32.9-37.3) weeks. Anal sphincter biometry, including external anal sphincter (EAS) length and thickness, EAS proximal rotational asymmetry, and internal anal sphincter thickness, was assessed blinded against other data.Results-A test-retest series showed good repeatability (intraclass correlation coefficients, 0.619-0.849) of all parameters. The mean age of the women (n = 111) was 30.9 (range, 18.8-40.5) years. None reported anal incontinence. On tomographic imaging, none showed anal sphincter defects. The mean EAS length was 17.5 (range, 8.4-34.8) mm, being shorter dorsally at 16.4 (range, 7.0-32.7) mm versus 18.7 (range, 7.5-36.9) mm ventrally (P < .001). The ventral EAS reached farther cranially by 0.8 AE 2.5 (range, -4.8-5.1) mm on average. The mean EAS thickness was 3.4 (range, 2.0-5.8) mm, being thicker dorsally than ventrally (P < .001).Conclusions-Anal sphincter biometry can be assessed with good repeatability by TLUS. The EAS seems longer ventrally. Asymmetry of the EAS could result in a false-positive diagnosis of defects in women in whom the ventral EAS terminates more caudally than its dorsal aspect, which seems uncommon. Hence, the likelihood of a false-positive diagnosis of substantial defects of the EAS using the published method seems low.

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Normal Female Anal Sphincter

Abstract: The female sphincter has a variable natural defect occurring along its anterior length. This makes interpretation of the isolated endoanal ultrasound difficult and explains previous overreporting of obstetric sphincter defects.

Cited by 77 publications

References 10 publications

Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound

Normal Values of Anal Sphincter Biometry by 4‐Dimensional Translabial Ultrasound: A Retrospective Study of Pregnant Women in Their Third Trimester

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