The utility of endovaginal sonography in the evaluation of fecal incontinence

Abstract

Objective: the endoanal sonography in female patients with faecal incontinence is sometimes difficult and can lead to diagnostic errors. The aim of this study is to evaluate the value of endovaginal sonography in such cases.Material and method: thirty female patients complaining of faecal incontinence are included in the study. Anal endosonography was performed in all of them in a single ambulatory session, pictures were taken from all along the anal and results were analyzed afterward. Vaginal endosonography was then perfomed using the same equipment. Result from both techniques were compared.Results: endoanal sonography was performed in all 30 patients. In 17 cases no anomalies were found. In 3 patients a simple internal anal sphincter defect was found. One case showed a lateral lesion in both sphincters. Six cases presented anterior external defect and in the rest 3 cases a clear view of the anterior wall was imposible. Vaginal endosonography shows a clear image of the anal canal in 23 out of 30 patients. In two cases changed the results of anal endosonography.Conclusion: in the study of faecal incontinence, despite of its technical limitations, endovaginal ulltrasound could be of help when the anterior wall of the anal canal is not properly defined.

Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

“…According to Poen et al, diagnostic perfor-mance may increase by as much as 25% in cases of faecal incontinence and perianal sepsis (21), and is especially indicated in multiparous women with recurrent septic conditions or fistula tracks located in the rectovaginal wall. However, other studies demonstrate the technical difficulties involved in obtaining adequate images of the anal canal via the endovaginal route due to the impossibility of making adequate contact between the probe and posterior vaginal wall (22), and recommend the use of this complementary route only when there is doubt as to the integrity of the anterior wall of the anal duct.…”

Sonographic Evaluation of Obstetric Anal Injuries

“…However, among the limitations of this technique is the difficult interpretation of the images which have been reported in up to 24% of the cases, requiring more experienced operators and the increased possibility of failure in obtaining clear images of the full length of the anal canal, mainly due to inadequate acoustic contact within the vagina. 73,74 Furthermore TVUS demonstrated limited precision in revealing lateral tears probably as a result of the lack of anal distention which keeps the muscular fibers relaxed hiding the defect through overlapping. 74…”