Can Anal Sphincter Defects Be Identified by Palpation?

Ka Lai Shek, Ixora Kamisan @ Atan, Hans Peter Dietz

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. Methods This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging. Results Two hundred forty-five patients were seen after primary repair of OASIs. Mean age was 29 (17-43) years. They were assessed at a median of 58 (15-278) days postpartum. One hundred fifty-seven (64%) delivered normal vaginally, 72 (29%) delivered by vacuum, and 16 (7%) delivered by forceps. A comparison of external anal sphincter (EAS) and internal anal sphincter ultrasound volume data and palpation was possible in 220 and 212 cases, respectively. Sphincter defects at rest and on contraction were both detected clinically in 17 patients. Significant abnormalities of the EAS were diagnosed on tomographic ultrasound imaging in 99 cases (45%), and significant abnormalities of the internal anal sphincter were diagnosed in 113 cases (53%). Agreement between digital and sonographic findings of sphincter defect was poor (k = 0.03-0.08). Women with significant EAS defects on ultrasound were found to have a lower resistance to digital insertion (P = 0.018) and maximum anal squeeze (P = 0.009) on a 6-point scale. The difference was however small. Conclusions Digital rectal examination does not seem to be sufficiently sensitive to diagnose residual sphincter defects after primary repair of OASIs. Imaging is required for the evaluation of sphincter anatomy after repair.

Original languageEnglish
Pages (from-to)472-475
Number of pages4
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume22
Issue number6
DOIs
Publication statusPublished - 1 Nov 2016

Fingerprint

Palpation
Anal Canal
Obstetrics
Digital Rectal Examination
Ultrasonography
Wounds and Injuries
Vacuum
Surgical Instruments
Postpartum Period
Anatomy
Cross-Sectional Studies
Interviews

Keywords

  • anal sphincter
  • imaging
  • levator ani
  • obstetric trauma
  • ultrasound

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynaecology
  • Urology

Cite this

Can Anal Sphincter Defects Be Identified by Palpation? / Shek, Ka Lai; Kamisan @ Atan, Ixora; Dietz, Hans Peter.

In: Female Pelvic Medicine and Reconstructive Surgery, Vol. 22, No. 6, 01.11.2016, p. 472-475.

Research output: Contribution to journalArticle

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abstract = "Objectives The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. Methods This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging. Results Two hundred forty-five patients were seen after primary repair of OASIs. Mean age was 29 (17-43) years. They were assessed at a median of 58 (15-278) days postpartum. One hundred fifty-seven (64{\%}) delivered normal vaginally, 72 (29{\%}) delivered by vacuum, and 16 (7{\%}) delivered by forceps. A comparison of external anal sphincter (EAS) and internal anal sphincter ultrasound volume data and palpation was possible in 220 and 212 cases, respectively. Sphincter defects at rest and on contraction were both detected clinically in 17 patients. Significant abnormalities of the EAS were diagnosed on tomographic ultrasound imaging in 99 cases (45{\%}), and significant abnormalities of the internal anal sphincter were diagnosed in 113 cases (53{\%}). Agreement between digital and sonographic findings of sphincter defect was poor (k = 0.03-0.08). Women with significant EAS defects on ultrasound were found to have a lower resistance to digital insertion (P = 0.018) and maximum anal squeeze (P = 0.009) on a 6-point scale. The difference was however small. Conclusions Digital rectal examination does not seem to be sufficiently sensitive to diagnose residual sphincter defects after primary repair of OASIs. Imaging is required for the evaluation of sphincter anatomy after repair.",
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