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Relationship Between External Anal Sphincter Atrophy at Endoanal Magnetic Resonance Imaging and Clinical, Functional, and Anatomic Characteristics in Patients With Fecal Incontinence

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Diseases of the Colon & Rectum

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Purpose

External anal sphincter atrophy at endoanal magnetic resonance imaging has been associated with poor outcome of anal sphincter repair. We studied the relationship between external anal sphincter atrophy on endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence.

Methods

In 200 patients (mean Vaizey score, 18 (±2.9 standard deviation)) magnetic resonance images were evaluated for external anal sphincter atrophy (none, mild, or severe) by radiologists blinded to anorectal functional test results and details from medical history. Subgroups of patients with and without atrophy were compared for medical history, anal manometry, pudendal nerve latency testing, anal sensitivity testing, external anal sphincter thickness, and external anal sphincter defects. Whenever significant differences were detected, we tested for differences between patients with mild and severe atrophy.

Results

External anal sphincter atrophy was demonstrated in 123 patients (62 percent): graded as mild in 79 (40 percent), and severe in 44 patients (22 percent). Patients with atrophy were more often female (P < 0.001) and older (P = 0.003). They had a lower maximal squeeze (P = 0.01) and squeeze increment pressure (P < 0.001). Patients with severe atrophy had a lower maximal squeeze (P = 0.003) and squeeze increment pressure (P < 0.001) than patients with mild atrophy. These effects were not attenuated by potential confounding variables. Patients with atrophy could not be identified a priori by other characteristics.

Conclusions

External anal sphincter atrophy at endoanal magnetic resonance imaging was depicted in 62 percent of patients, varying from mild to severe. Because increasing levels of atrophy were associated with impaired squeeze function, further studies are needed to evaluate whether grading atrophy is clinically valuable in selecting patients for anal sphincter repair.

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Acknowledgment

The authors thank C. Lavini, M.Phil., for assistance.

Author information

Authors and Affiliations

  1. Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Maaike P. Terra M.D., Annette C. Dobben M.Sc. & Jaap Stoker M.D., Ph.D.

  2. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Marije Deutekom Ph.D. & Patrick M. M. Bossuyt Ph.D.

  3. Department of Radiology, Academic Hospital Maastricht, Maastricht, The Netherlands

    Regina G. H. Beets-Tan M.D., Ph.D.

  4. Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands

    Alexander F. Engel M.D., Ph.D.

  5. Department of Surgery, University Medical Center Utrecht, Utrect, The Netherlands

    Lucas W. M. Janssen M.D., Ph.D.

  6. Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Guy E. E. Boeckxstaens M.D., Ph.D.

  7. Department of Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands

    Cor G. M. I. Baeten M.D., Ph.D.

  8. Department of Radiology, Zaans Medical Center, Zaandam, The Netherlands

    Jacobus A. de Priester M.D., Ph.D.

  9. Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Maaike P. Terra M.D.

Authors
  1. Maaike P. Terra M.D.
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  2. Marije Deutekom Ph.D.
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  3. Regina G. H. Beets-Tan M.D., Ph.D.
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  4. Alexander F. Engel M.D., Ph.D.
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  5. Lucas W. M. Janssen M.D., Ph.D.
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  6. Guy E. E. Boeckxstaens M.D., Ph.D.
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  7. Annette C. Dobben M.Sc.
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  8. Cor G. M. I. Baeten M.D., Ph.D.
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  9. Jacobus A. de Priester M.D., Ph.D.
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  10. Patrick M. M. Bossuyt Ph.D.
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  11. Jaap Stoker M.D., Ph.D.
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Corresponding author

Correspondence to Maaike P. Terra M.D..

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Supported by grant 945-01-013 of the Netherlands Organization for Health Research and Development.

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Terra, M.P., Deutekom, M., Beets-Tan, R.G.H. et al. Relationship Between External Anal Sphincter Atrophy at Endoanal Magnetic Resonance Imaging and Clinical, Functional, and Anatomic Characteristics in Patients With Fecal Incontinence. Dis Colon Rectum 49, 668–678 (2006). https://doi.org/10.1007/s10350-006-0507-4

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