Diseases of the Colon & Rectum

, Volume 37, Issue 12, pp 1296–1299 | Cite as

Vaginal endosonography

New approach to image the undisturbed anal sphincter
  • A. H. Sultan
  • P. B. Loder
  • C. I. Bartram
  • M. A. Kamm
  • C. N. Hudson
Original Contributions


PURPOSE: Although anal endosonography provides clear images of anal sphincters, the probe in the anal canal may distort epithelial structures and sphincter muscles may be compressed, producing inaccurate muscle thickness measurements. The aim of this study is to describe a new approach using vaginal endosonography to image the anal canal undistorted. METHODS: Twenty females (10 healthy volunteers and 10 with fecal incontinence) had both anal and vaginal endosonography performed. RESULTS: The undisturbed anorectum, submucosa, anal cushions, and anal sphincter muscles were clearly visualized by vaginal endosonography, and anatomy was described. Although anal and vaginal endosonographic measurements of internal sphincter muscle thickness correlated (r=0.83;P=0.01), anal endosonography consistently underestimated the thickness (2.3±0.5 vs. 3.2±1.2 mm; mean ± standard deviation). Anterior internal and external anal sphincter defects were identified accurately with both techniques. CONCLUSIONS: Vaginal endosonography is a new technique that enables accurate imaging of anal sphincters and epithelial structures at rest. In addition to making the diagnosis of anal sphincter defects, it has potential applications in the imaging of anovaginal sepsis and malignancy and possibly in understanding the pathogenesis of anal fissure and hemorrhoids.

Key words

Anal endosonography Anal sphincters Pelvic floor musculature vaginal endosonography Pelvic anatomy 


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Copyright information

© American Society of Colon and Rectal Surgeons 1994

Authors and Affiliations

  • A. H. Sultan
    • 1
    • 3
  • P. B. Loder
    • 2
    • 3
  • C. I. Bartram
    • 4
  • M. A. Kamm
    • 3
  • C. N. Hudson
    • 1
  1. 1.Department of Obstetrics and GynaecologySt. Bartholomew's (Homerton) HospitalLondonUK
  2. 2.Department of PhysiologySt. Mark's HospitalLondonUK
  3. 3.Department of SurgerySt. Mark's HospitalLondonUK
  4. 4.Department of RadiologySt. Mark's HospitalLondonUK

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