Abstract
Background3-dimensional anorectal manometry (3DARM) and 3-dimensional endoanal ultrasound (3DEAUS) have not been used to assess the anal sphincter complex (ASC) in primi gravida. This study was conducted to identify any correlation that may exist between 3DARM and 3DEAUS.Methods We analyzed 3DARM and 3DEAUS data of 101 consecutive primi mothers assessed in the late second trimester or early 3rd trimester. 3DARM was performed using the Given Imaging® Manoscan system and 3DEAUS was performed with the Olympus® RU 12M-R1 probe and EU-ME1 ultrasound system.ResultsThe mean age was 24.7 (SD—5.1) years. All patients had a normal Cleveland Clinic Incontinence Score. The mean resting pressure (RP) was 87.02 (SD—18.43) mmHg and the maximum squeeze pressure (SP) was 179.21 (SD—52.96) mmHg. The mean length of the high pressure zone was 3.67 (SD—0.52) cm. On 3DEAUS, there were three characteristic segments of the ASC that were identified; upper, middle and lower. Mean thicknesses for both internal anal sphincter (IAS) and external anal sphincter (EAS) were identified for primi gravida. IAS was thicker anteriorly and at 9 o’ clock positions and EAS was thicker posteriorly. There was good correlation in the length of the ASC at each quadrant between 3DARM and 3DEAUS. There was no correlation between either RP or SP thickness of IAS or EAS at each level and quadrant.ConclusionCorrelation is seen only in the length of ASC at each quadrant. No correlation exist between RP or SP and thickness of IAS and EAS.
Highlights
Galen and Versalius [1] are acknowledged as the first to describe and illustrate the anal sphincter complex (ASC)
Our results indicate that in Asian primi gravida, the resting pressure (RP), squeeze pressure (SP) and high pressure zone (HPZ) length are comparable but higher than the values for other Asian females [13] but similar to Caucasian females aged less than 50 years [14]
There was no asymmetry of the external anal sphincter (EAS) at 3 and 9 o’ clock positions but there is lateral asymmetry in the internal anal sphincter (IAS) where it is thicker at 9 o’ clock position, The ASC was longest laterally as identified by both 3-dimensional anorectal manometry (3DARM) and 3-dimensional endoanal ultrasound (3DEAUS), and there was no correlation with RP and SP with thickness of either sphincter at the corresponding level
Summary
Galen and Versalius (as quoted by Wexner) [1] are acknowledged as the first to describe and illustrate the anal sphincter complex (ASC). First attempts at assessing the anal sphincter pressures were made more than half a century ago [2] and anorectal manometry (ARM) was first used in assessing patients in the 1980s. Endoscopic ultrasound was first used in the assessment of the ASC in 1990 at the St. Mark’s Hospital, London, UK [8]. Mark’s Hospital, London, UK [8] It showed a good correlation with electromyography (EMG) [9] which was considered the gold standard. EAUS has a good correlation with surgical findings [10] and histological/dissection studies [11]. Three dimensional EAUS (3DEAUS) was used for patient assessment a decade later [12,13,14]
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