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Clin Colon Rectal Surg 2008; 21(3): 157-166
DOI: 10.1055/s-2008-1080995
© Thieme Medical Publishers

Transrectal Ultrasound, Manometry, and Pudendal Nerve Terminal Latency Studies in the Evaluation of Sphincter Injuries

Brooke Gurland1 , Tracy Hull1
  • 1Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Publication History

Publication Date:
24 July 2008 (online)

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ABSTRACT

Fecal incontinence may be due to postpartum anal sphincter injuries or neurological damage even in the absence of obvious perineal trauma. Anal physiologic testing with transrectal ultrasound, manometry, and pudendal nerve terminal latency studies help to identify those patients with anal sphincter injuries who might benefit from anal sphincter repair. In this article, the authors discuss the specific tests that are available and how to interpret them.

KEYWORDS

Anal sphincter injuries - fecal incontinence - anal physiology testing

REFERENCES

  • 1 Johanson J F, Lafferty J. Epidemiology of fecal incontinence: the silent affliction.  Am J Gastroenterol. 1996;  91 33-36
    PubMedGoogle Scholar
  • 2 Sultan A H, Kamm M A, Hudson C N et al.. Anal sphincter disruption during vaginal delivery.  N Engl J Med. 1993;  329 1956-1957
    CrossrefPubMedGoogle Scholar
  • 3 Donnelly V, O'Connell P R, O'Herlihy C. The influence of oestrogen replacement on faecal incontinence in post menopausal women.  Br J Obstet Gynaecol. 1997;  104 311-315
    PubMedGoogle Scholar
  • 4 Nichols C M, Ramakrishnan V, Gill E J, Hurt W G. Anal incontinence in women with and those without pelvic floor disorders.  Obstet Gynecol. 2005;  106(6) 1266-1271
    PubMedGoogle Scholar
  • 5 Willis S, Faridi A, Schelzig S et al.. Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery.  Arch Surg. 2002;  387 101-107
    CrossrefPubMedGoogle Scholar
  • 6 Zetterstrom J, Mellgren A, Jensen L L et al.. Effects of delivery on anal sphincter morphology and function.  Dis Colon Rectum. 1999;  42 1253-1260
    CrossrefPubMedGoogle Scholar
  • 7 Varma A, Gunn J, Gardiner A, Lindow S W, Duthie G S. Obstetric anal sphincter injury: prospective evaluation of incidence 1999.  Dis Colon Rectum. 1999;  42 1537-1543
    PubMedGoogle Scholar
  • 8 Abramowitz L, Sobhani I, Ganansia R et al.. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study.  Dis Colon Rectum. 2000;  43 590-598
    PubMedGoogle Scholar
  • 9 Chaliha C, Kalia V, Sultan A H, Monga A K, Stanton S L. Anal function: effect of pregnancy and delivery.  Am J Obstet Gynecol. 2001;  185 427-432
    CrossrefPubMedGoogle Scholar
  • 10 Snooks S J, Swash M, Setchell M, Henry M M. Injury to the innervation of the pelvic floor sphincter musculature in childbirth.  Lancet. 1984;  2 546-550
    PubMedGoogle Scholar
  • 11 Snooks S J, Swash M, Mathers S E, Henry M M. Effect of vaginal delivery on the pelvic floor—a five year follow up.  Br J Surg. 1990;  77 1358-1360
    PubMedGoogle Scholar
  • 12 Rao S S, Patel R S. How useful are manometric tests of anorectal functions in the management of defecation disorders?.  Am J Gastroenterol. 1997;  92 469-475
    PubMedGoogle Scholar
  • 13 Deen K I, Kumar D, Williams J G, Oliff J, Keighley M R. Anal sphincter defects: correlation between endoanal ultrasound and surgery.  Ann Surg. 1993;  218 201-205
    CrossrefPubMedGoogle Scholar
  • 14 Tjandra J J, Milsom J W, Schroeder T, Fazio V W. Endoluminal ultrasound is preferable to electromyography in mapping anal sphincter defects.  Dis Colon Rectum. 1993;  36 689-692
    PubMedGoogle Scholar
  • 15 Sultan A H, Loder P B, Bartram C I, Kamm M A, Hudson C N. Vaginal endosonography: new approach to image the undisturbed anal sphincter.  Dis Colon Rectum. 1994;  37 1296-1299
    CrossrefPubMedGoogle Scholar
  • 16 Lee J H, Pretorius D H, Weinstein M, Guaderrama N M, Nager C W, Mittal R K. Transperineal three-dimensional ultrasound in evaluating anal sphincter muscles.  Ultrasound Obstet Gynecol. 2007;  30(2) 201-209
    PubMedGoogle Scholar
  • 17 Voyvodic F, Rieger Na, Skinner S et al.. Endosonographic imaging of anal sphincter injuries: does the size of the tear correlate with the degree of dysfunction?.  Dis Colon Rectum. 2003;  46 735-741
    CrossrefPubMedGoogle Scholar
  • 18 Sentovich S M, Wong W D, Blatchford G J. Accuracy and reliability of transanal ultrasound for anterior anal sphincter injury.  Dis Colon Rectum. 1998;  41 1000-1004
    PubMedGoogle Scholar
  • 19 Sultan A H, Kamm M A, Hudson C N, Nicholls J R, Bartram C I. Endosonography of the anal sphincters: normal anatomy and comparison with manometry.  Clin Radiol. 1994;  49 368-374
    PubMedGoogle Scholar
  • 20 Zetterstrom J P, Mellgren A, Madoff R, Kim D, Wong D. Perineal body measurements improves evaluation of anterior sphincter lesions during endo anal ultrasonography.  Dis Colon Rectum. 1998;  41 705-713
    PubMedGoogle Scholar
  • 21 Oberwalder M, Thaler K, Baig M, Dinnewitzer A, Efron J, Weiss E. Anal ultrasound and endo sonographic measurements of perineal body thickness: a new evaluation for fecal incontinence in females.  Surg Endosc. 2004;  18 650-654
    CrossrefPubMedGoogle Scholar
  • 22 Gold D M, Halligan S, Kmiot W A, Bartram C I. Intraobserver and interobserver agreement in anal endosonography.  Br J Surg. 1999;  86 371-375
    CrossrefPubMedGoogle Scholar
  • 23 Williams A B, Bartram C I, Halligan S, Spencer J A, Nicholls R J, Kmiot W A. Anal sphincter damage after vaginal delivery using three dimensional endosonography.  Obstet Gynecol. 2001;  97 770-775
    CrossrefPubMedGoogle Scholar
  • 24 Pfeifer J, Oliveira L. Anorectal manometry and the rectoalanal inhibitory reflex. In: Wexner SD, Duthie GS Constipation, Etiology, Evaluation and Management. New York, NY; Thieme Medical Publishers 2006: 71-78
    Google Scholar
  • 25 Jorge J M, Wexner S D. A practical guide to basic anorectal physiology investigations.  Contemp Surg. 1996;  43 214-224
    PubMedGoogle Scholar
  • 26 Schuster M M. Biofeedback treatment of gastrointestinal disorders.  Med Clin North Am. 1977;  61 907-912
    PubMedGoogle Scholar
  • 27 Pfeifer J, Oliveira L, Park U C, Gonzales A, Nogueras J J, Wexner S D. The relation of normal manometry to age and gender.  Tech Coloproctol. 1996;  4 10-13
    PubMedGoogle Scholar
  • 28 Ahran P, Faverdin C, Persoz B et al.. Relationship between viscoelastic properties of the rectum and anal pressures in man.  J Appl Physiol. 1976;  41 677-704
    PubMedGoogle Scholar
  • 29 Hancke E, Schurholz M. Impaired rectal sensation in idiopathic fecal incontinence.  Int J Colorectal Dis. 1987;  2 146-148
    CrossrefPubMedGoogle Scholar
  • 30 Rasmussen O O. Anorectal function.  Dis Colon Rectum. 1994;  37 386-403
    CrossrefPubMedGoogle Scholar
  • 31 Hill J, Hosker G, Kiff E. Pudendal nerve terminal motor latency measurements: what they do and do not tell us.  Br J Surg. 2002;  89 1268-1269
    CrossrefPubMedGoogle Scholar
  • 32 Ricciardi R, Mellgren A F, Madoff R D et al.. The utility of pudendal nerve terminal latencies in idiopathic incontinence.  Dis Colon Rectum. 2006;  49 852-857
    CrossrefPubMedGoogle Scholar
  • 33 Gilliland R, Altomare D, Moreira H, Oliveira L, Gilliland J, Wexner S. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty.  Dis Colon Rectum. 1998;  41 1516-1522
    CrossrefPubMedGoogle Scholar

Brooke GurlandM.D. 

Department of Colorectal Surgery, Cleveland Clinic Foundation

Desk A-30, 9500 Euclid Ave., Cleveland, OH 44195

Email: gurlanb@ccf.org

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