Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women
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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.
KeywordsAnal manometry Anal sphincter complex Three-dimensional ultrasound Vaginal manometry
external anal sphincter
factorial analysis of variance
Fecal Incontinence Severity Index
internal anal sphincter
Incontinence Impact Questionnaire, short form
Urinary Distress Inventory, Short Form
Financially supported by NIH RO1 grant DK60733
Conflict of interest
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