Open AccessThree‐dimensional endoanal ultrasound assessment of the anal sphincters during rest and squeeze
Author(s) -
OLSEN INGRID P.,
AUGENSEN KÅRE,
WILSGAARD TOM,
KISERUD TORVID
Publication year - 2008
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1080/00016340802088346
Subject(s) - medicine , endoanal ultrasound , external anal sphincter , anal canal , internal anal sphincter , rest (music) , sphincter , vaginal delivery , ultrasound , anal sphincter , fecal incontinence , surgery , urethral sphincter , rectum , radiology , urethra , pregnancy , biology , genetics
Abstract Background. Current ultrasound assessment of the anal sphincter is based on measurements during rest. However, active constriction plays a role in maintaining continence. Here we assess female anal dimensions during rest and squeeze. Methods . Thirty women were recruited for a cross‐sectional endoanal ultrasound study after written consent according to an ethically approved protocol: nine 0‐gravida, 10 with normal vaginal delivery, and 11 with complicated vaginal delivery (babies >4,500 g, operative vaginal delivery or perineal rupture). Endoanal three‐dimensional (3D)‐ultrasound volume was obtained during rest and squeeze. Length of anal canal and volume of the external and internal sphincters were determined. Results . In the 0‐gravida group, the mean anal canal at rest was 3.28 cm (SD: ±0.63) compared with 2.30 (±0.77) in those who had given birth ( p =0.002). Correspondingly, the volume of the external sphincter was 7.61 cm 3 (±2.63) versus 4.80 (±2.02) ( p =0.004), and for the internal sphincter 2.63 (±1.18) versus 2.68 (±1.30) ( p =0.98). There were no differences between rest and squeeze within the 0‐gravida, but after a traumatic vaginal delivery the internal sphincter was smaller during squeeze ( p =0.01), and the overlap between external and internal sphincter was 0.76 cm (±0.41), insignificantly shorter ( p =0.09) than in the 0‐gravida group at 1.21 (±0.62). Conclusions . Women with vaginal delivery had a shorter anal canal and smaller external sphincter than 0‐gravida. Active squeeze had no effect on the dimensions of the sphincter apart from a reduction of the internal sphincter in those who had undergone a complicated delivery, possibly due to a dislodging upwards during squeeze.