Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women

  • Milena M. Weinstein
  • Dolores H. Pretorius
  • Sung-Ae Jung
  • Jennifer J. Wan
  • Charles W. Nager
  • Ravinder K. Mittal
Original Article


Introduction and hypothesis

We aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women.


3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups.


Forty-four of 45 subjects had adequate PRM images. The injured PRM (N = 14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N = 30; p = 0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon.


In asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.


Anal manometry Anal sphincter complex Three-dimensional ultrasound Vaginal manometry 



three-dimensional ultrasound


external anal sphincter


factorial analysis of variance


Fecal Incontinence Severity Index


internal anal sphincter


Incontinence Impact Questionnaire, short form


puborectalis muscle


Urinary Distress Inventory, Short Form



Financially supported by NIH RO1 grant DK60733

Conflict of interest



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Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • Milena M. Weinstein
    • 1
    • 2
  • Dolores H. Pretorius
    • 1
    • 3
  • Sung-Ae Jung
    • 1
    • 4
    • 5
  • Jennifer J. Wan
    • 1
  • Charles W. Nager
    • 1
    • 6
  • Ravinder K. Mittal
    • 1
    • 4
  1. 1.The Pelvic Floor Function and Disorder GroupUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of Vincent Gynecology, Division of Urogynecology and Reconstructive Pelvic SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of RadiologyUniversity of CaliforniaSan DiegoUSA
  4. 4.Department of Internal Medicine, Division of GastroenterologyUniversity of CaliforniaSan DiegoUSA
  5. 5.Ewha Womans University College of MedicineSeoul CityRepublic of Korea
  6. 6.Department of Reproductive Medicine, Division of Urogynecology and Reconstructive Pelvic SurgeryUniversity of CaliforniaSan DiegoUSA

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