Relationship Between External Anal Sphincter Atrophy at Endoanal Magnetic Resonance Imaging and Clinical, Functional, and Anatomic Characteristics in Patients With Fecal Incontinence

Terra, Maaike P.; Deutekom, Marije; Engel, Alexander; Janssen, Luuk M.; Boeckxstaens, Guy E.; Dobben, Annette C.; Baeten, C. G. M. I.; Priester, Jacobus A. de; Bossuyt, Patrick M.; Stoker, Jaap

doi:10.1007/s10350-006-0507-4

Cited by 29 publications

(11 citation statements)

References 43 publications

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“…Reduced anal resting and squeeze pressures are associated with IAS and EAS injury, respectively. 7–9 However, endoanal probes distort the anal canal, precluding an assessment of the anal seal. In this study, MRI with a torso coil identified a patulous anal canal in 41% of all patients and 58% of patients with FI.…”

Section: Discussionmentioning

confidence: 99%

Relationship Among Anal Sphincter Injury, Patulous Anal Canal, and Anal Pressures in Patients With Anorectal Disorders

Prichard

Harvey

Fletcher

et al. 2015

Clinical Gastroenterology and Hepatology

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Background & Aims The anal sphincters and puborectalis are routinely imaged with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. Using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal sphincter and puborectalis injury, a patulous anal canal, and anal pressures. Methods We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomical parameters were evaluated with univariate and multivariate analyses. Results Fecal incontinence (55 patients, 46%) and constipation (36 patients. 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P≤.001) and internal sphincter (P<.01), but not puborectalis (P=.09) or external sphincter (P=.06) injury. Internal (P<.01) and external sphincter injury (P=.02) and a patulous canal (P<.001), but not puborectalis injury, predicted anal resting pressure. A patulous anal canal was the only significant predictor (P<.01) of the anal squeeze pressure increment. Conclusions Patients with anorectal disorders commonly have a patulous anal canal, associated with more severe anal injury, anal resting pressure, and squeeze pressure increment. It is therefore important to identify patulous anal canal because it appears to be a marker of not only anal sphincter injury but disturbances beyond sphincter injury, such as damage to the anal cushions or anal denervation.

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Section: Discussionmentioning

confidence: 99%

Relationship Among Anal Sphincter Injury, Patulous Anal Canal, and Anal Pressures in Patients With Anorectal Disorders

Prichard

Harvey

Fletcher

et al. 2015

Clinical Gastroenterology and Hepatology

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“…Esto incide en el número de pacientes incluidos en los estudios 11 . Al realizar una búsqueda en la literatura para poder comparar nuestros resultados, nos encontramos con numerosos trabajos que estudian la IF evaluando las alteraciones del conducto anal mediante diferentes métodos diagnósticos, como la EAUS, la manometría endoanal 12 , la resonancia magnética endoanal 13 y la ultrasonografía transperineal 14 . Estos trabajos se enfocan en comparar los métodos de estudio y en analizar la presencia de alteraciones en un grupo con IF versus un grupo control.…”

Section: Discussionunclassified

Relación Entre El Grado De Incontinencia Fecal Y El Daño Del Esfínter Anal Externo

et al. 2015

Rev Chil Cir

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relationship between faecal incontinence severity and external anal sphincter disruption introduction: Faecal incontinence (FI) represents an important psychological and social condition for an individual. There are several causes for FI, therefore its study and management is complex. Among different aetiologies, anatomical disruption of the external anal sphincter (EAS) as a consequence of anorrectal surgery or obstetric injury can be studied by endoanal ultrasound (EAUS). This study focus on anatomical assessment of sphincter muscle injury of EAS and its relationship with clinical presentation con FI. Objective: Compare anatomical and disruption of EAS features studied by 3D-EAUS between patients with FI, according to its severity. methods: 3D-EAUS images were obtained from selected patients studied for FI between January 2008 and July 2010 at Clínica las Condes. Wexner Score (SW) was used to evaluate severity of FI, dividing patients into two categories: Mild FI (SW < 9) and Severe FI (SW ≥ 9). A single observer evaluated different morphological variables: width, length, percentage and angle of EAS disruption. Parametrical and non-parametrical analysis was used as appropriate. P-value < 0.05 was considered statistically significant. results: From 31 female patients studied, mean SW was 11.7 ± 0.8 points, range from 5 to 20 points. When dividing into two groups, 9 patients had mild FI and 22 had severe FI. Studied variables in EAUS 3D cubes: width, length, percentage and angle of EAS disruption, did not reach statistical significance between groups. conclusion: no relationship was found between external anal sphincter anatomic injury variables studied and severity of faecal incontinence.

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“…The thickness of the external anal sphincter has been measured at the 9 o'clock position using 2-D axial MR images with and without the use of an endoanal coil and found to correlate with squeeze on manometric testing [6]. External anal sphincter thickness and volume has also been quantified using 3-D endoanal ultrasonography [7,8].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the main body of the external anal sphincter muscle cross-sectional area between women with and without prolapse

et al. 2007

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The aim of the study was to compare the main body of the external anal sphincter (EAS) crosssectional area (CSA) of women with and without pelvic organ prolapse. Pelvic magnetic resonance imaging (MRI) scans of 40 women were selected for analysis. Of these women, 20 had pelvic organ prolapse and 20 had normal support. Of the women with normal support, 10 had known major levator ani (LA) muscle defects and 10 had normal LA muscles. The same was true for the women with pelvic prolapse: half had major LA defects and half had no LA defects. All patients had previously completed pelvic MRI in the supine position. 3-D models of the EAS were made and CSA of the EAS perpendicular to the fiber direction were measured circumferentially at 30° intervals. Univariable and multivariable analyses were performed. The mean CSA did not significantly differ between women with prolapse and normal support regardless of LA defect status (normal/−LA defect=1.13 cm 2 , prolapse/−LA defect=0.86 cm 2 , p=0.065; normal/+LA defect=1.08 cm 2 , prolapse/ +LA defect=1.28 cm 2 , p=0.28). Women with prolapse and LA defects had a 49% larger mean muscle CSA compared to prolapse patients without LA defects (p=0.01). This difference associated with defect status in prolapse patients was not seen in women with normal support. Women with prolapse alone had external anal sphincter CSAs that were comparable to women with normal support. However, women with both prolapse and a major levator ani defect had larger external anal sphincter CSAs compared to prolapse patients without levator ani defects.

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Relationship Between External Anal Sphincter Atrophy at Endoanal Magnetic Resonance Imaging and Clinical, Functional, and Anatomic Characteristics in Patients With Fecal Incontinence

Cited by 29 publications

References 43 publications

Relationship Among Anal Sphincter Injury, Patulous Anal Canal, and Anal Pressures in Patients With Anorectal Disorders

Relationship Among Anal Sphincter Injury, Patulous Anal Canal, and Anal Pressures in Patients With Anorectal Disorders

Relación Entre El Grado De Incontinencia Fecal Y El Daño Del Esfínter Anal Externo

Comparison of the main body of the external anal sphincter muscle cross-sectional area between women with and without prolapse

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