Anal endosonography for assessment of anal incontinence with a linear probe: relationships with clinical and manometric features

Abstract.

Background and aims: This study determined correlations of clinical and manometric features with those of anal endosonography (AES). Patients and methods: Between 1996 and 1999 we examined 58 patients suffering from anal incontinence (AI) by AES using a linear probe and anorectal manometry following a standardized protocol. Results: Twelve of the 58 patients (21%) had a history of anal surgery. Of the 40 women who had undergone at least one vaginal delivery 22 (55%) sustained an obstetric tear and 12 (30%) required forceps for delivery. A perineal descent was observed in 24 of 32 women with AI (75%) and urinary incontinence in 24 of 44 (54%). An anal sphincter defect was diagnosed in 45 of the 58 patients (77%). The internal anal sphincter defects occurring in 42 patients (72%) were significantly associated with a decrease in the resting anal pressure. The external anal sphincter defects occurring in 33 patients (57%) were significantly associated with a decrease in the voluntary anal contraction. Conclusion: Considering AES and manometric findings, a good correlation was observed between internal sphincter defect and the resting anal pressure and between external sphincter defects and the voluntary anal contraction. AI is usually associated with a global perineal insufficiency requiring special attention in terms of both training and medical management.