Anal Sphincter Damage After Vaginal Delivery Using Three-Dimensional Endosonography

Williams, A. O.; Bartram, Clive I.; Halligan, Steve; Spencer, John; Nicholls, R. J.; Kmiot, W. A.

doi:10.1097/00006250-200105000-00024

Cited by 57 publications

(80 citation statements)

References 20 publications

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“…After a vaginal delivery without a clinically recognised sphincter tear, endosonographic sphincter defects have been observed with a frequency of 7% to 41% (3)(4)(5)(6)(7)(8)(9)(10)(11). We have found 20% (5/25) of non-pregnant nullipara with no symptoms of anal incontinence to have sphincter defects at anal endosonography.…”

Section: Introductionmentioning

confidence: 69%

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Effect of vaginal delivery on endosonographic anal sphincter morphology

Starck

Bohe

Valentin

2007

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To describe the effect of vaginal delivery with no clinically recognized sphincter tear on endosonographic anal sphincter morphology and sphincter pressure and to relate endosonographic results to anal sphincter pressure and anal incontinence score.Study design: Thirty-two nullipara underwent anal endosonography and anal manometry in the third trimester of pregnancy, 2 weeks and 6 months post-partum. The sphincter defect scores (1-16) and the thickness and length of the sphincters were measured by endosonography, and sphincter pressures and manometric sphincter lengths were determined.The Wexner incontinence score (1-20) was used to classify anal incontinence 6 months post partum.Results: Five (16%) women had small endosonographic anal sphincter defects (score 3 -4) before delivery. Eight women (25%; confidence interval 11 -43%) had new defects detected post partum, five small, one moderate (score 7), and two large (score 10 -11). Six (75%) of eight women with new defects post-partum had undergone episiotomy vs. five (21%) of 24 women with no new defects (p=0.02). Six months after delivery 16 (50%) women reported anal incontinence, and there was a positive correlation between the endosonographic defect score 6 months post partum and the Wexner incontinence score. The sphincter was significantly longer during pregnancy than 6 months post partum.Conclusion: New sphincter defects may arise after vaginal delivery without any clinically recognizable sphincter tear. There is a positive correlation between the endosonographic defect score 6 months post partum and the Wexner incontinence score.

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Section: Introductionmentioning

confidence: 69%

“…There are conflicting reports with regard to a possible association between sphincter defects and the results of anal manometry (3)(4)(5)(7)(8)(9)(10)(11). We have introduced an endosonographic sphincter defect score to describe the extension of sphincter defects (2).…”

Section: Introductionmentioning

confidence: 99%

Effect of vaginal delivery on endosonographic anal sphincter morphology

Starck

Bohe

Valentin

2007

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Two-dimensional ultrasonography is limited by the single plane of view and can be used to measure the extent of the defect circumferentially (radial angle in degrees or in hours of the clock) (3,6,8,20,21) . The recent development of 3-DAUS using 360° field-of-view transducers provides a topographical overview of anal canal anatomy and allows measurement of length, thickness, area of sphincter defect in the sagittal and coronal planes, and volume of sphincter damage (18,22,24,27) . Few studies have reported on the contribution of this modality in the evaluation of anal canal anatomy in patients with fecal incontinence (18,24,26,27) .…”

Section: Discussionmentioning

confidence: 99%

“…The recent development of 3-DAUS using 360° field-of-view transducers provides a topographical overview of anal canal anatomy and allows measurement of length, thickness, area of sphincter defect in the sagittal and coronal planes, and volume of sphincter damage (18,22,24,27) . Few studies have reported on the contribution of this modality in the evaluation of anal canal anatomy in patients with fecal incontinence (18,24,26,27) . In previous reports, we have demonstrated the asymmetrical shape of the anal canal and compared anal sphincter positions and lengths between the sexes (18) The anterior EAS and the IAS have been described as shorter in women, producing a longer gap with a less resistant upper anal canal TABLE 5.…”

Section: Discussionmentioning

confidence: 99%

“…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) .…”

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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