Age effects on anorectal pressure in anal continent women with lower urinary tract dysfunction

Abstract

The objective of this paper is to evaluate age and associated factors affecting anorectal pressure profilometry in anal-continent women with lower urinary tract symptoms. One hundred and ten anal-continent women (mean age, 47.7+/-12.8 years; range, 23-87 years) with lower urinary tract symptoms voluntarily participated in this study after undergoing a complete urogynecological evaluation including a multichannel urodynamic study. Anorectal pressure was evaluated by using a radial four-channel manometry with a water-filled catheter, which was placed 10 cm into the anorectum above the anal verge. We divided the anorectal pressure profile into five segments and four axes to clarify the axis-specific defect or site-specific damage in the sphincter profile. The aging process had a negative effect on the peak resting pressure from the 41 to 100th percentile of the anorectal pressure profile at 12 o'clock, 3 o'clock, and 6 o'clock (P<0.05). With voluntary squeezing, aging had negative effects on the peak squeeze pressure from the 41 to 100th percentile of the anorectal pressure profile at 3 o'clock, and 61 to 80 percentile at 12 o'clock (P<0.05). There is a trend where anorectal pressure reduces as a woman ages, especially at the anal sphincter area in women with lower urinary tract symptoms. The anterior and left sides of the anorectal sphincter seem to be the most vulnerable in the aging process.

Combined estrogen and ghrelin administration decreases expression of p27kip1 and proportion of isomyosin type I in the striated urethral and anal sphincters and levator ani of old ovariectomized rats

“…Likewise, skeletal muscle gene expression profiles of p27 kip1 are increased in elderly women reflecting increased DNA damage and increased fiber regeneration [23]. The increased cytoplasmic p27 kip1 expression observed in the striated pelvic floor muscles of old ovariectomized rats in our study was only reversed by ghrelin administration and not by estrogen replacement, further supporting an independent adverse effect of ageing on these muscles [1][2][3]12].…”

“…To date, the independent adverse effect of normative ageing on deterioration of urinary and fecal control has rarely been studied in postmenopausal women [1][2][3][4]. We examined this hypothesis in ovariectomized Fisher 344 rats that is an appropriate animal model with prolonged life span (30 months) and similar pelvic floor anatomy for analyzing the effects of ageing and menopause on structures maintaining continence in women [5].…”

Factors associated with fecal incontinence in women with lower urinary tract symptoms

“…Among these studies, Perry et al . found fecal incontinence to be more prevalent and more severe in their older participants, 23 leading them to hypothesize that it may be associated with decreased anal sphincter power with aging 24 . In another study of a similar population, Joh et al .…”

Ageing of the female pelvic floor: towards treatment a la carte of the “geripause”

“…Animal models like our own can offer an ideal testing system for investigating the pathogenesis of ageing of the female pelvic floor and for conducting further targeted therapeutic human studies on hypotheses validated in animals [24]. The research mandate is to identify safe, effective, and disease-specific a la carte pharmacological intervention for geripausal women with support-related pelvic floor dysfunction as a supplement or substitute to estrogen replacement [7][8][9][10][11][12].…”