Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence

Abstract

To evaluate the frequency and spectrum of lesions of different pelvic floor muscles at endoanal MRI in women with severe faecal incontinence and to study their relation with incontinence severity and manometric findings. In 105 women MRI examinations were evaluated for internal anal sphincter (IAS), external anal sphincter (EAS), puborectal muscle (PM) and levator ani (LA) lesions. The relative contribution of lesions to differences in incontinence severity and manometric findings was studied. IAS (n = 59) and EAS (n = 61) defects were more common than PM (n = 23) and LA (n = 26) defects. PM and LA defects presented mainly with IAS and/or EAS defects (isolated n = 2 and n = 3). EAS atrophy (n = 73) was more common than IAS (n = 19), PM (n = 16) and LA (n = 9) atrophy and presented mainly isolated. PM and LA atrophy presented primarily with EAS atrophy (isolated n = 3 and n = 1). Patients with IAS and EAS lesions had a lower resting and squeeze pressure, respectively; no other associations were found. PM and LA lesions are relatively common in patients with severe faecal incontinence, but the majority of lesions are found in women who also have IAS and/or EAS lesions. Only an association between anal sphincter lesions and manometry was observed.

A pictorial overview of pubovisceral muscle avulsions on pelvic floor magnetic resonance imaging

“…The Translabial 3D-Ultrasonography for Diagnosing Levator Defects (TRUDIL) study is currently being performed to estimate the diagnostic accuracy of 3D US compared with MR imaging [30]. Specific MR imaging techniques can be used to evaluate pubovisceral muscle avulsions, such as endoanal MR imaging [31]. In this paper, however, images obtained with T2-weighted MR imaging using an external surface coil were used.…”

Evaluation of the Role of the Puborectal Part of the Levator Ani Muscle in Anal Incontinence: A Prospective Study of 78 Female Patients With Anal Incontinence

“…Results in the literature found PR muscle ruptures by the use of MRI in 20% and 22% of patients and by the use of 3D-EAUS in 36% patients. 25,21,20 In the latter study, it is noteworthy that isolated lesions of the PR muscle and the LA concerned 2% and 3% of patients. PR muscle ruptures are, in fact, recognized less frequently than those of the EAS and IAS.…”

“…The correlation between PR damage and ARM is controversial: for certain authors, it definitely exists, for others, it does not. 5,21 Rupture of the anal sphincters is recognized as responsible for AI. 22 3D-EAUS is an effective examination with good intra-and interobserver reproducibility for detecting ruptures of the PR muscle.…”

ACR Appropriateness Criteria Pelvic Floor Dysfunction

“…Determining the presence of atrophy can help predict the success of sphincter defect repair in patients being considered for surgery [60]. Concurrent abnormalities of the levator ani muscle complex are also demonstrated on MRI [61,62].…”