Anal endosonography in the investigation of faecal incontinence

Law, Penelope; Kamm, Michael A.; Bartram, Clive I.

doi:10.1002/bjs.1800780315

Cited by 231 publications

(79 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Traditionally, anal endosonography has been performed using a 7 mHz rotating transducer with a focal length of 1-4 cm (87). It provides an assessment of the thickness and structural integrity of the external and internal anal sphincter muscle and can detect the presence of scarring, loss of muscle tissue, and other local pathology (87,88).…”

Section: Imaging the Anal Canalmentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

284

295

View full text Add to dashboard Cite

DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

show abstract

Section: Imaging the Anal Canalmentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

284

295

View full text Add to dashboard Cite

show abstract

“…The development of imaging techniques that involve the use of endoluminal devices-endoluminal ultrasonography (US) and endoluminal magnetic resonance (MR) imaging-resulted in good visualization of the anal sphincter. This development made possible a better understanding of the pathologic condition by showing that sphincteric lesions are the main cause of fecal incontinence (3,4). Consequently, detailed imaging of the sphincter became important in the diagnosis and treatment of the disease.…”

Section: Introductionmentioning

confidence: 99%

Endoanal MR Imaging of the Anal Sphincter in Fecal Incontinence

Rociu¹,

Stoker²,

Zwamborn³

et al. 1999

RadioGraphics

View full text Add to dashboard Cite

Fecal incontinence is a major medical and social problem. The most frequent cause is a pathologic condition of the anal sphincter. Endoanal magnetic resonance (MR) imaging allows detailed visualization of the normal anatomy and pathologic conditions of the anal sphincter. The hyperintense internal sphincter appears as a continuation of the smooth muscle of the rectum; the hypointense external sphincter surrounds the lower part of the internal sphincter. A sphincteric defect is seen as a discontinuity of the muscle ring. Scarring appears as a hypointense deformation of the normal pattern of the muscle layer. Two external sphincteric patterns may be misdiagnosed as defects: a posterior discontinuity (often seen in young male patients) and an anterior discontinuity (often seen in female patients). Atrophy of the external sphincter is easily detected on coronal MR images by comparing the thicknesses of all anal muscles. Endoanal MR imaging is superior to endoanal ultrasonography because of the multiplanar capability and higher inherent contrast resolution of the former. Use of endoanal MR imaging may lead to better selection of candidates for surgery and therefore better surgical results. Endoanal MR imaging is the most accurate technique for detection and characterization of sphincteric lesions and planning of optimal therapy.

show abstract

“…Anal ultrasonography is a well-established method for identification of sphincter defects, and correlates well with surgical findings (3,10) . Recent advances in technology and the advent of three-dimensional ultrasonography have enabled multiplanar study of anal canal anatomy and measurement of the length and volume of the anal canal muscles (22,27) .…”

Section: Introductionmentioning

confidence: 90%

Do Changes in Anal Sphincter Anatomy Correlate With Anal Function in Women With a History of Vaginal Delivery?

Murad-Regadas

Dealcanfreitas

Regadas

et al. 2014

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Objectives -To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods -Female with fecal incontinence and vaginal delivery were assessed with Wexner's score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Results -Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions -Fecal incontinence symptoms did not correlate with anal pressures and anal sphincter anatomy changes, but women with sphincter defects have shorter anterior EAS and IAS and a longer gap.

show abstract

Anal endosonography in the investigation of faecal incontinence

Cited by 231 publications

References 14 publications

Diagnosis and Management of Fecal Incontinence

Diagnosis and Management of Fecal Incontinence

Endoanal MR Imaging of the Anal Sphincter in Fecal Incontinence

Do Changes in Anal Sphincter Anatomy Correlate With Anal Function in Women With a History of Vaginal Delivery?

Contact Info

Product

Resources

About