Abstract
PURPOSE: The aim of the study was to evaluate the use of anal endosonography in idiopathic incontinence. METHODS: In 29 patients and 26 normal controls, the relationship between sonography images and physiologic parameters was studied. RESULTS: External anal sphincter function, measured as fiber density by single-fiber electromyography (P=0.0001) and pudendal nerve terminal motor latency (P=0.04), was significantly impaired in patients with idiopathic incontinence compared with controls. Both the external and internal anal sphincter could be identified by anal endosonography, and the thickness directly measured. The thickness of the external anal sphincter was significantly negatively correlated to muscle fiber density (r=−0.65,P=0.0002) and to pudendal nerve distal conduction velocity (r=−0.74,P=0.008). The thickness of the internal anal sphincter was significantly correlated to resting pressure (r=−0.67,P=0.0001). CONCLUSION: The ratio between the thickness of the external and internal sphincter muscles measured on the sonography screen was significantly reduced in patients with neurogenic incontinence compared with controls (P <0.01).
Similar content being viewed by others
References
Bartolo DC, Jarratt JA, Read NW. The use of conventional electromyography to assess external sphincter neuropathy in man. J Neurol Neurosurg Psychiatry 1983;46:1115–8.
Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.
Beersiek F, Parks AG, Swash M. Pathogenesis of anorectal incontinence; a histometric study of the anal canal musculature. J Neurol Sci 1979;42:111–27.
Neill ME, Swash M. Increased motor unit fibre density in the external anal sphincter muscle in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 1980;43:343–7.
Neill ME, Parks AG, Swash M. Physiological studies of the pelvic floor in idiopathic faecal incontinence and rectal prolapse. Br J Surg 1981;68:531–6.
Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.
Wei Ming Sun, Read NW, Donnelly TC. Impaired internal anal sphincter in a subgroup of patients with idiopathic fecal incontinence. Gastroenterology 1989;97:130–5.
Law PJ, Bartram CI. Anal endosonography: Technique and normal anatomy. Gastrointest Radiol 1989;14:349–53.
Mulder CJ, Tio TL, Tytgat GN. Transrectal ultrasonography in the assessment of perianorectal fistula and/or abscess in Crohn's disease. Gastroenteroloy 1988;94:A313.
Law PJ, Talbot RW, Bartram CI, Northover JM. Anal endosonography in the evaluation of perianal sepsis and fistula in ano. Br J Surg 1989;76:752–5.
Law PJ, Kamm MA, Bartram CI. A comparison between electromyography and anal endosonography in mapping external anal sphincter defects. Dis Colon Rectum 1990;33:370–3.
Eckardt VF, Nix W. The anal sphincter in patients with myotonic muscular dystrophy. Gastroenterology 1991;100:424–30.
Stålberg E, Thiele B. Motor unit fibre density in the extensor digitorum communis muscle. J Neurol Neurosurg Psychiatry 1975;38:874–80.
Swash M. Anorectal incontinence: electrophysiological tests. Br J Surg 1985;72(Suppl):S14–22.
Bartram CI, Burnett SJ. Atlas of anal endosonography. Oxford: Butterworth-Heinemann, 1991.
Nielsen MB, Hauge C, Rasmussen O, Pedersen JF, Christiansen J. Anal endosonographic findings in the follow-up of primarily sutured sphincteric ruptures. Br J Surg 1992;79:104–6.
Bannister JJ, Abouzekry L, Read NW. Effect of aging on anorectal function. Gut 1987;28:353–7.
Enck P, Kuhlbusch R, Lubke H, Frieling T, Erckenbrecht JF. Age and sex and anorectal manometry in incontinence. Dis Colon Rectum 1989;32:1026–30.
Swash M, Gray A, Lubowski DZ, Nicholls RJ. Ultrastructural changes in internal anal sphincter in neurogenic faecal incontinence. Gut 1988;29:1692–8.
Speakman CT, Hoyle CH, Kamm MA, Henry MM, Nicholls RJ, Burnstock G. Adrenergic control of the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence. Br J Surg 1990;77:1342–4.
Kuijpers HC, Scheuer M. Disorders of impaired fecal control. Dis Colon Rectum 1990;33:207–11.
Rogers J, Laurberg S, Misiewicz JJ, Henry MM, Swash M. Anorectal physiology validated: a repeatability study of the motor and sensory tests of anorectal function. Br J Surg 1989;76:607–9.
Jacobs PP, Scheuer M, Kuijpers JH, Vingerhoets MH. Obstetric fecal incontinence: role of pelvic floor denervation and results of delayed sphincter repair. Dis Colon Rectum 1990;33:494–7.
Author information
Authors and Affiliations
About this article
Cite this article
Emblem, R., Dhaenens, G., Stien, R. et al. The importance of anal endosonography in the evaluation of idiopathic fecal incontinence. Dis Colon Rectum 37, 42–48 (1994). https://doi.org/10.1007/BF02047213
Issue Date:
DOI: https://doi.org/10.1007/BF02047213