Abstract
Follow-up was performed two to six years after anal dilatation for fissure-in-ano in 32 consecutive patients who had not undergone additional anal surgery. All patients were interviewed and asked specifically about impairment of flatus or fecal control and its possible relation to the anal dilatation. Anal dilatation was followed by minor anal incontinence in 12.5 percent of the patients. Anal endosonographic follow-up was accepted by 20 patients, and sphincteric defects were found in 13 (65 percent) of those. Two patients with anal incontinence had internal sphincter defects. Sphincteric defects were also found in 11 of the 18 continent patients who underwent sonography: internal sphincter defects in nine, external sphincter defect in one, and combined defects of both sphincter muscles in one. In conclusion, anal dilatation results in sphincter damage in more than half of patients, but few of them develop anal incontinence.
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References
MacIntyre IM, Balfour TW. Results of the Lord non-operative treatment for haemorrhoids. Lancet 1972;1:1094–5.
Watts JM, Bennett RC, Goligher JC. Stretching of anal sphincters in treatment of fissure-in-ano. BMJ 1964;2:342–3.
Snooks S, Henry MM, Swash M. Faecal incontinence after anal dilatation. Br J Surg 1984;71:617–8.
Speakman CT, Burnett SJ, Kamm MA, Bartram CI. Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg 1991;78:1429–30.
Nielsen MB, Pedersen JF, Hauge C, Rasmussen O, Christiansen J. Endosonography of the anal sphincter: findings in healthy volunteers. AJR 1991;157:1199–202.
Nielsen MB, Hauge C, Rasmussen OØ, SØrensen M, Pedersen JF, Christiansen J. Anal sphincter size measured by endosonography in healthy volunteers. Effect of age, sex and parity. Acta Radiol 1992;33:453–6.
Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg 1991:78:312–4.
Nielsen MB, Hauge C, Rasmussen OØ, Pedersen JF, Christiansen J. Anal endosonographic findings in the follow-up of primarily sutured sphincteric ruptures. Br J Surg 1992;79:104–6.
Renter JA, Keeman JN. Long-term follow-up of Lord's procedure for haemorrhoids. Neth J Surg 1983;35:17–9.
Jensen SL, Lund F, Nielsen OV, Tange G. Lateral subcutaneous sphincterotomy versus anal dilatation in the treatment of fissure in ano in outpatients: a prospective randomised study. BMJ 1984;289:528–30.
Asfar SK, Juma TH, Ala-Edeen T. Haemorrhoidectomy and sphincterotomy: a prospective study comparing the effectiveness of anal stretch and sphincterotomy in reducing pain after haemorrhoidectomy. Dis Colon Rectum 1988;31:181–5.
Mortensen PE, Olsen J, Pedersen IK, Christiansen J. A randomized study on haemorrhoidectomy combined with anal dilatation. Dis Colon Rectum 1987;30:755–7.
Kamm MA, Hoyle CHV, Burleigh DE,et al. Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition. Gastroenterology 1991;100:805–10.
Nielsen MB, Rasmussen OØ, Pedersen JF, Christiansen J. Anal endosonographic findings in patients with obstructed defecation. Acta Radiol 1993;34:35–8.
Burnett SJ, Spence-Jones C, Speakman CT, Kamm MA, Hudson CN, Bartram CI. Unsuspected sphincter damage following childbirth revealed by anal endosonography. Br J Radiol 1991;64:225–7.
Cuesta MA, Meijer S, Derksen EJ, Boutkan H, Meuwissen SG. Anal sphincter imaging in fecal incontinence using endosonography. Dis Colon Rectum 1992;35:59–63.
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Nielsen, M.B., Rasmussen, O.Ø., Pedersen, J.F. et al. Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano. Dis Colon Rectum 36, 677–680 (1993). https://doi.org/10.1007/BF02238595
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DOI: https://doi.org/10.1007/BF02238595