Anal Endosonography and Incontinence

  • Abdul H. Sultan


Anal endosonography followed modification of the rectal endoprobe (B&K Medical, Gentofte, Denmark) first described in 1982 by Frentzel-Beyme1 for imaging the prostate gland. In 1986, using the same probe, Beynon et al.2 clarified the interpretation of endosonic appearances of normal colon and rectum. For the purposes of anal endosonography, Law and Bartram modified the tip of the probe by replacing the water-filled balloon with a hard sonolucent plastic cone measuring 17 mm in diameter (Figure 14.1). The rotating endoprobe is fitted with a 7 or preferably a 10 MHz transducer (focal range 5–45 mm), which provides a 360° cross-sectional image.


Faecal Incontinence Anal Sphincter Internal Anal Sphincter Anal Incontinence Sphincter Defect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Frentzel-Beyme B (1982) Die transrektale prostatasonogra- phie. Computertomogr Sonogr Juni 2(2):58–112Google Scholar
  2. 2.
    Beynon J, Foy DMA, Temple LN et al. (1986) The endosonic appearances of the normal colon and rectum. Dis Colon Rectum 29:810–813PubMedCrossRefGoogle Scholar
  3. 3.
    Law PJ, Bartram CI (1989) Anal endosonography: technique and normal anatomy. Gastrointest Radiol 14:349–353PubMedCrossRefGoogle Scholar
  4. 4.
    Sultan AH, Kamm MA, Hudson CN et al. (1994) Endosonography of the anal sphincters: normal anatomy and comparison with manometry. Clin Rad 49:368–374CrossRefGoogle Scholar
  5. 5.
    Sultan AH (1995) The effect of childbirth on the anal sphincters as demonstrated by anal endosonography and anorectal physiology. MD Thesis, University of Natal, South AfricaGoogle Scholar
  6. 6.
    Sultan AH, Nicholls RJ, Kamm MA et al. (1993) Anal endosonography and correlation with in vitro and in vivo anatomy. Br J Surg 80:508–511PubMedCrossRefGoogle Scholar
  7. 7.
    Sultan AH, Kamm MA, Talbot IC et al. (1994) Anal endosonography: precision of identifying sphincter defects confirmed histologically. Br J Surg 81:466–469CrossRefGoogle Scholar
  8. 8.
    Sultan AH, Kamm MA, Nicholls RJ et al. (1994) Internal anal sphincter division during lateral sphincterotomy. Prospective ultrasound study. Dis Colon Rectum 37:1031–1033PubMedCrossRefGoogle Scholar
  9. 9.
    Vaizey CJ, Kamm MA, Bartram CI (1997) Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence. Lancet 349:612–615.PubMedCrossRefGoogle Scholar
  10. 10.
    Sultan AH, Loder PB, Bartram CI et al. (1994) Vaginal endosonography: a new technique to image the undisturbed anal sphincter. Dis Colon Rectum 37:1296–1299PubMedCrossRefGoogle Scholar
  11. 11.
    Poen AC, Felt-Bersma RJF, Cuesta MA et al. (1998) Vaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis. Br J Surg 85:359–363PubMedCrossRefGoogle Scholar
  12. 12.
    Meyenberger C, Bertschinger P, Zala GF et al. (1996) Anal sphincter defects in fecal incontinence: correlation between endosonography and surgery. Endoscopy 28:217–224PubMedCrossRefGoogle Scholar
  13. 13.
    Donnelly V, Fynes M, Campbell D et al. (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961PubMedCrossRefGoogle Scholar
  14. 14.
    Peschers UM, DeLancey JOL, Schaer GN et al. (1997) Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol 104:999–1003PubMedCrossRefGoogle Scholar
  15. 15.
    Stoker J, Hussain SM, Lameris JS (1996) Endoanal magnetic resonance imaging versus endosonography. La Radiologia Medica 92:738–741PubMedGoogle Scholar
  16. 16.
    MacArthur C, Bick DE, Keighley MRB (1997) Faecal incontinence after childbirth. Br J Obstet Gynaecol 104:46–50PubMedCrossRefGoogle Scholar
  17. 17.
    Allen RE, Hosker GL, Smith ARB et al. (1990) Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 97:770–779PubMedCrossRefGoogle Scholar
  18. 18.
    Sultan AH, Kamm MA, Hudson CN et al. (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMedCrossRefGoogle Scholar
  19. 19.
    Chaliha C, Sultan AH, Bland M (2001) Anal function: effect of pregnancy and delivery. Am J Obstet Gynecol 185:427–432PubMedCrossRefGoogle Scholar
  20. 20.
    Johanson RB, Rice C, Doyle M et al. (1993) A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. Br J Obstet Gynaecol 100:524–530PubMedCrossRefGoogle Scholar
  21. 21.
    Bofill JA, Rust OA, Schorr SJ et al. (1996) A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. Am J Obstet Gynecol 175:1325–1330PubMedCrossRefGoogle Scholar
  22. 22.
    Sultan AH, Kamm MA, Bartram CI et al. (1993) Anal sphincter trauma during instrumental delivery. A comparison between forceps and vacuum extraction. Int J Gynecol Obstet 43:263–270CrossRefGoogle Scholar
  23. 23.
    Sultan AH, Johanson RB, Carter JE (1998) Occult anal sphincter trauma following randomized forceps and vacuum delivery. Int J Gynecol Obstet 61:113–119CrossRefGoogle Scholar
  24. 24.
    Sultan AH (1997) Anal incontinence after childbirth. Curr Opin Obstet Gynecol 9:320–324PubMedGoogle Scholar
  25. 25.
    Poen AC, Felt-Bersma RJF, Strijers RLM et al. (1998) Third- degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg 85:1433–1438PubMedCrossRefGoogle Scholar
  26. 26.
    Sultan AH, Kamm MA, Hudson CN et al. (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891PubMedGoogle Scholar
  27. 27.
    Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRefGoogle Scholar
  28. 28.
    Engel AF, Kamm MA, Sultan AH et al. (1994) Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg 81:1231–1234PubMedCrossRefGoogle Scholar
  29. 29.
    Sultan AH, Monga AK, Kumar D et al. (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 106:318–323PubMedCrossRefGoogle Scholar
  30. 30.
    Engel AF, Kamm MA, Bartram CI (1995) Unwanted anal penetration as a physical cause of faecal incontinence. Europ J Gastroenterol Hepatol 7:65–67Google Scholar
  31. 31.
    Speakman CTM, Burnett SJD, Kamm MA et al. (1991) Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg 78:1429–1430PubMedCrossRefGoogle Scholar
  32. 32.
    Khubchandani IT, Reed JF (1989) Sequelae of internal sphincterotomy for chronic fissure in ano. Br J Surg 76:431–434PubMedCrossRefGoogle Scholar
  33. 33.
    Bennett RC, Friedman MHW, Goligher JC (1963) Late results of haemorrhoidectomy by ligature and excision. BMJ 2:216–219.PubMedCrossRefGoogle Scholar
  34. 34.
    Kennedy HL, Zegarra JP (1990) Fistulotomy without external sphincter division for high anal fistula. Br J Surg 77:898–901PubMedCrossRefGoogle Scholar
  35. 35.
    Sultan AH, Kamm MA (1993) Ultrasound of the anal sphincter. In: Schuster MA (ed) Atlas of gastrointestinal motility: in health and disease. Williams and Wilkins, Baltimore, pp 115–120Google Scholar

Copyright information

© Springer-Verlag London Limited 2003

Authors and Affiliations

  • Abdul H. Sultan

There are no affiliations available

Personalised recommendations