The current role of imaging techniques in faecal incontinence

Abstract

Faecal incontinence is a common multifactorial disorder. Major causes of faecal incontinence are related to vaginal delivery and prior anorectal surgery. In addition to medical history and physical examination, several anorectal functional tests and imaging techniques can be used to assess the underlying pathophysiology and to guide treatment planning in faecal incontinent patients. Anorectal functional tests provide functional information, but the potential strength comes from combining test results. Imaging techniques, including defecography, endoanal sonography, and magnetic resonance (MR) imaging, provide structural information about the anorectal region with a direct clinical impact. The major role of imaging techniques in faecal incontinence is visualising the structural and functional integrity of the anal sphincter complex. Both two-dimensional endoanal sonography and endoanal MR imaging are accurate tools to depict anal sphincter defects. The major advantage of endoanal MR imaging is the accurate demonstration of external anal sphincter atrophy. Recent studies have suggested that external phased array MR imaging and three-dimensional endoanal sonography are also valuable tools in the diagnostic work up of faecal incontinence. Decisions about the preferred technique will mainly be determined by availability and local expertise. This article demonstrates the current role of tests, predominantly imaging tests, in the diagnostic work up of faecal incontinence.

Time-Resolved MRI After Ingestion of Liquids Reveals Motility Changes After Laparoscopic Sleeve Gastrectomy—Preliminary Results

“…The bSSFP sequence family is characterized by very short repetition times, thus allowing for imaging with a high temporal resolution [18]. Variants of the sequences used in this study are, for example, commonly used for cardiac imaging or MR defecography [19,20]. The assessment of gastric motility has likewise been subject of examinations based on comparable MR techniques.…”

Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders

“…We identifi ed ten severe rectal prolapses in the orthostatic position, three of which were graded as moderate in the supine position (Fig. 4); fi ve [9]. moderate prolapses in the orthostatic position, one of which was graded as mild it the supine position; and three mild prolapses in the orthostatic position, which were all missed in the supine position.…”

“…Moreover, physical examination is often diffi cult and inadequate for a complete anatomical and functional assessment of the pelvis [9].…”

Radiologic Evaluation of Pelvic Floor Disorders

“…30 Anal endosonography can accurately demonstrate abnormal IAS thickness because the borders of this smooth muscle are sharply limited. 32 In contrast, EAS atrophy is more difficult to identify by means of two-dimensional anal endosonography. Recently, three-dimensional anal endosonography has been described and seems promising.…”