Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery

Willis, S.; Faridi, Andreé; Schelzig, S.; Hoelzl, F.; Kasperk, Reinhard; Rath, Werner; Schumpelick, Volker

doi:10.1007/s00423-002-0296-8

Cited by 38 publications

(27 citation statements)

References 27 publications

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“…Nonetheless, our results suggest that women who have an episiotomy are at higher risk than those who have not of having a sonographic anal sphincter defect, and that women delivered with the assistance of uterine pressure are at higher risk of larger defects. In agreement with other research teams we found sphincter pressure to decrease soon after delivery (3,4,8,10), but to have recovered after 6 months. Our results suggest that the anal sphincter is longer during pregnancy than in the non-pregnant state (statistically significant difference), and that it may be slightly thicker (non-significant difference).…”

Section: Discussionsupporting

confidence: 93%

“…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%

“…Endosonographic sphincter defects are not always associated with anal incontinence (4)(5)(6)(8)(9)(10)(11). 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).…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of vaginal delivery on endosonographic anal sphincter morphology

Starck

Bohe

Valentin

2007

European Journal of Obstetrics & Gynecology and Reproductiv

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“…In addition, anal electrosensitivity normalized 6 months after uneventful delivery. Perception threshold and threshold for urgency measured by rectal balloon distension was not affected by childbirth [49]. …”

Section: Discussionmentioning

confidence: 99%

Influence of Gender and Age on Anorectal Function: Normal Values from Anorectal Manometry in a Large Caucasian Population

Gundling

Seidl²,

Scalercio³

et al. 2010

Digestion

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Introduction: In the literature, data on the effects of gender and age on the pressure data of anorectal manometry differ. Possible reasons are investigation of only small numbers of healthy people and comparison of only 2 groups with large age differences. In addition, data about the influence of gender or age on anorectal sensation are sparse. Therefore, the aim of the present study was to determine the influence of gender and age on anorectal manometry in a large healthy female and male cohort spanning a great age range. Methods: Anorectal manometry was performed in 72 women and 74 men with a median age of 64 years in both groups (ranges: women 22–90 years; men 23–88 years). We determined mean anal resting and squeeze pressure as well as minimal rectal balloon volume for perception and for urge/desire to defecate. The Mann-Whitney U test was used to analyze for gender differences, regression analysis to search for age influences. Results: Squeeze pressure (p = 0.007) and perception threshold (p < 0.001) are significantly lower in females, while the mean resting pressure and urge threshold are similar in females and males. Mean resting pressure (women p < 0.0001; men p = 0.03) and mean squeeze pressure decrease (women p < 0.0001; men p = 0.004) with age. An age-related increase in sensory thresholds (= decreased rectal sensitivity) is only seen in females (perception threshold p = 0.01; urge threshold p = 0.04). Conclusion: Most of the parameters measured by anorectal manometry (anal canal pressure, sensory thresholds) are influenced by gender and age. Therefore, the results of anorectal manometry must be interpreted in relation to sex- and age-adapted normal values.

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Innervation asymmetry of the external anal sphincter in aging characterized from high‐density intra‐rectal surface EMG recordings

Dias

Zhang

et al. 2018

Neurourology and Urodynamics

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Our work demonstrates, for the first time, that EAS functional innervation tends to become increasingly asymmetrical with advancing age, and this increase is associated with a compromised anorectal function. Results suggest that the intra-rectal HD-sEMG will serve as an advanced tool for assessing and monitoring the anorectal neuromuscular function minimally invasively under different pathophysiological conditions.

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Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery

Abstract: Vaginal delivery leads to direct mechanical trauma to the anal sphincters, while stretch and distension of the pudendal nerve seem to be of minor importance. Only endoanal ultrasonography is suitable for detection of occult sphincter lesions.

Cited by 38 publications

References 27 publications

Effect of vaginal delivery on endosonographic anal sphincter morphology

Effect of vaginal delivery on endosonographic anal sphincter morphology

Influence of Gender and Age on Anorectal Function: Normal Values from Anorectal Manometry in a Large Caucasian Population

Innervation asymmetry of the external anal sphincter in aging characterized from high‐density intra‐rectal surface EMG recordings

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