Anal sphincter trauma and anal incontinence in urogynecological patients

R. A. Guzmán Rojas, Ixora Kamisan @ Atan, K. L. Shek, H. P. Dietz

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma. Methods This was a retrospective analysis of ultrasound volume datasets of 501 patients attending a tertiary urogynecological unit. All patients underwent a standardized interview including determination of St Mark's score for those presenting with AI. Tomographic ultrasound imaging (TUI) was used to evaluate the EAS and the internal anal sphincter (IAS). Results Among a total of 501 women, significant EAS and IAS defects were found in 88 and 59, respectively, and AI was reported by 69 (14%). Optimal prediction of AI was achieved using a model that included four abnormal slices of the EAS on TUI. IAS defects were found to be less likely to be associated with AI. In a multivariable model controlling for age and IAS trauma, the presence of at least four abnormal slices gave an 18-fold (95% CI, 9-36; P <0.0001) increase in the likelihood of AI, compared with those with fewer than four abnormal slices. Using receiver-operating characteristics curve statistics, this model yielded an area under the curve of 0.86 (95% CI, 0.80-0.92). Conclusions Both AI and significant EAS trauma are common in patients attending urogynecological units, and are strongly associated with each other. Abnormalities of the IAS seem to be less important in predicting AI. Our data support the practice of using, as a minimal criterion, defects present in four of the six slices on TUI for the diagnosis of significant EAS trauma.

Original languageEnglish
Pages (from-to)363-366
Number of pages4
JournalUltrasound in Obstetrics and Gynecology
Volume46
Issue number3
DOIs
Publication statusPublished - 1 Sep 2015

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Anal Canal
Wounds and Injuries
Ultrasonography
ROC Curve
Obstetrics
Area Under Curve
Interviews

Keywords

  • 3D/4D ultrasound
  • anal incontinence
  • anal sphincter
  • anal sphincter trauma
  • fecal incontinence
  • transperineal ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

Cite this

Anal sphincter trauma and anal incontinence in urogynecological patients. / Guzmán Rojas, R. A.; Kamisan @ Atan, Ixora; Shek, K. L.; Dietz, H. P.

In: Ultrasound in Obstetrics and Gynecology, Vol. 46, No. 3, 01.09.2015, p. 363-366.

Research output: Contribution to journalArticle

Guzmán Rojas, R. A. ; Kamisan @ Atan, Ixora ; Shek, K. L. ; Dietz, H. P. / Anal sphincter trauma and anal incontinence in urogynecological patients. In: Ultrasound in Obstetrics and Gynecology. 2015 ; Vol. 46, No. 3. pp. 363-366.
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