Abstract
BackgroundAnal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence.Methods44 patients, (42 women, mean age: 64 (11) years), complaining of anal incontinence, underwent anal vector manometry, endo-anal ultrasonography (to assess sphincter defects) and pelvic viscerogram (for the diagnosis of rectal prolapse). Resting and squeeze anal pressures, and anal asymmetry index at rest and during voluntary squeeze were determined by vector manometry.ResultsUltrasonography identified 19 anal sphincter defects; there were 9 cases of overt rectal prolapse, and 14 other cases revealed by pelvic viscerogram (recto-anal intussuception). Patients with rectal prolapse had a significantly higher anal sphincter asymmetry index at rest, whether patients with anal sphincter defects were included in the analysis or not (30 (3) % versus 20 (2) %, p < 0.005). Among patients without rectal prolapse, a higher anal sphincter asymmetry index during squeezing was found in patients with anal sphincter defects (27 (2) % versus 19 (2) %, p < 0.03).ConclusionsIn anal incontinent patients, anal asymmetry index may be increased in case of anal sphincter defect and/or rectal prolapse. In the absence of anal sphincter defect at ultrasonogaphy, an increased anal asymmetry index at rest may point to the presence of a rectal prolapse.
Highlights
Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence
Endo-anal ultrasonography allows the identification of anal sphincter defects [1,2]; we have observed that patients with rectal prolapse occasionally revealed an asymmetrical aspect of the sphincter
We studied the results of anal vector manometry performed in 44 patients (42 women and 2 men, mean age: 64 years-old, range: 23 to 79) complaining of anal incontinence, in whom the diagnostic work-up included an anal ultrasonography (EAU) and a dynamic pelvic viscerogram (PV), allowing the identification of patients with anal sphincter defects and / or rectal prolapse
Summary
Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence This correlation is far from perfect, and other factors may play a role. We and others [3,4] have shown that some correlation exists between the radial size of external anal sphincter defects and increased anal asymmetry index This correlation is far from perfect and other factors such as rectal prolapse may be at bay to increase anal pressure asymmetry. The goal of this study was to assess the impact of both anal sphincter defects and rectal prolapse on the anal asymmetry index as determined by anal vector manometry
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