Anal Resting Pressures at Manometry Correlate with the Fecal Incontinence Severity Index and with Presence of Sphincter Defects on Ultrasound

Bordeianou, Liliana; Lee, Kil Yeon; Rockwood, Todd; Baxter, Nancy N.; Lowry, Ann C.; Mellgren, Anders; Parker, Susan C.

doi:10.1007/s10350-008-9230-7

Cited by 47 publications

(26 citation statements)

References 21 publications

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“…Although our results show no differences in continence scores between patients with and without symptoms and no correlation between muscle length, scores, and squeezing pressure as measured by anorectal manometry, we did observe a positive correlation between resting pressure and anterior EAS and IAS length on 3-DAUS in patients who had sphincter defects. These results are consistent with those of previous studies (2,22) , but all these measurements are relevant to therapeutic decision making, as ultrasound can differentiate between incontinent patients with intact anal sphincters and those with sphincter lesions, as well as associate anal pressures and symptoms, providing additional value to select patients for different treatment modalities. Fecal incontinence is multifactorial; different mechanisms are involved (12) and patients with fecal incontinence and intact sphincter may have muscle degeneration, atrophy, or pudendal neuropathy (19,23,25) .…”

Section: Eas Defect Plus Eas + Ias Defect (N = 33) Anterior Ias (Cm) Vssupporting

confidence: 91%

“…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) . Although some studies have reported poor correlation between symptoms, anal manometry pressures, and ultrasound measurements (4,5,22) , both studies should be offered to symptomatic patients (2) . A wide range of treatment modalities is available, including biofeedback, surgical sphincter repair, sacral nerve stimulation, and the artificial bowel sphincter, and a comprehensive assessment is required to identify anatomic and functional changes and inform the choice for the best treatment option.…”

Section: Introductionmentioning

confidence: 99%

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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.

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-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.

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Section: Eas Defect Plus Eas + Ias Defect (N = 33) Anterior Ias (Cm) Vssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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.

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“…Bordeianou et al [38] observed a correlation between MRP and severity, while Osterberg et al [22] found a correlation between MSP and severity. No correlation between severity and the pressure values was reported by Penninckx et al [24].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

et al. 2012

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Background/Aim: Patients with fecal incontinence (FI) have lower anal resting (MRP) and squeeze (MSP) pressure and an impaired sensitivity compared to healthy people. However, whether anorectal manometry (ARM) can separate precisely between health and disease is discussed controversially. The aim was to evaluate the accuracy of ARM in a huge cohort of patients and controls. Methods: ARM was obtained in 144 controls and in 559 FI patients. MRP, MSP, and balloon volume at first perception (BVP) and urge sensation (BVU) were determined. Receiver operating curve analysis was used to determine optimal cut-offs and sensitivity, specificity and accuracy calculated. Results: FI patients showed lower MRP, MSP, BVU (p < 0.001) and a higher BVP (p = 0.007). Deterioration of the ARM parameter increased with FI severity. ARM demonstrated an excellent sensitivity (91.4%) and accuracy (85.8%), but only a moderate specificity (62.5%). The sensitivity of ARM rose with FI severity. The pressure data showed higher sensitivity and accuracy than the sensory data despite comparable specificity. Conclusions: Sensitivity and accuracy of single ARM parameters is only moderate for the pressure data and poor for the sensory data. In contrast, ARM demonstrated an excellent sensitivity, a moderate specificity, and a convincing accuracy justifying its use in clinical routine.

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“…More treatment options for FI makes a proper pretreatment evaluation increasingly important, whether by means of subjective severity questionnaires, such as the FISI, or by objective measurements, such as ARM, anal endosonography, electromyography, and defecography [1]. Bordeianou et al [5] reported MRP was the only objective measurement that seems to correlate with both FISI and the presence of sphincteric defects on anal endosonography, while maximal squeeze pressure (MSP) generated by the EAS was not correlated. Our results confirm a strong association between low MRP and FI.…”

Section: Open Accessmentioning

confidence: 99%

“…The IAS contributes an estimated 55% -85% to maximal resting pressure (MRP) [3,4]. Low MRP is the most important predictor of FI and correlates with the Fecal Incontinence Severity Index (FISI) [5].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for internal anal sphincter dysfunction in Japanese adults

Abé¹,

Kono²,

Hachiro³

et al. 2013

OJGas

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Purpose: The internal anal sphincter provides most of the resting anal tone and is the main muscle responseble for continence. This study was designed to estimate the prevalence of, and identify risk factors associated with, internal anal sphincter dysfunction in Japanese adults. Methods: Anorectal manometry was performed in 1193 women and 1124 men aged 20 years or older. The maximal resting pressure, measured by a rapid pull-through technique, was defined as the highest resting pressure recorded. Internal anal sphincter dysfunction was defined as a maximal resting pressure less than 30 mmHg. Potential risk factors were assessed through self-reports, interviews, physical examinations, and medical record reviews. Multivariate logistic regression analysis was used to identify independent risk factors for internal anal sphincter dysfunction. Results: Significant differences in maximal resting pressure were seen between women (58.1 ± 24.9 mmHg) and men (68.8 ± 23.5 mmHg, P < 0.001). Maximal resting pressure decreased significantly with increasing age in both sexes. The prevalence of internal anal sphincter dysfunction was 10.4% (15.5% in women, 5.1% in men). In a multivariate logistic regression model, age, mental disease, pelvic organ prolapse repair, and fecal incontinence were independently associated with a greater risk of internal anal sphincter dysfunction in women and men. Conclusions: Internal anal sphincter dysfunction is a common problem for women and men. Several of the identified risk factors are preventable or modifiable, and may direct future research in fecal incontinence therapy.

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Anal Resting Pressures at Manometry Correlate with the Fecal Incontinence Severity Index and with Presence of Sphincter Defects on Ultrasound

Cited by 47 publications

References 21 publications

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

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

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

Risk factors for internal anal sphincter dysfunction in Japanese adults

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