nach oben

Erschienen in:

01.09.2011 | Original Article

Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women

verfasst von: Milena M. Weinstein, Dolores H. Pretorius, Sung-Ae Jung, Jennifer J. Wan, Charles W. Nager, Ravinder K. Mittal

Erschienen in: International Urogynecology Journal | Ausgabe 9/2011

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

We aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women.

Methods

3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups.

Results

Forty-four of 45 subjects had adequate PRM images. The injured PRM (N = 14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N = 30; p = 0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon.

Conclusions

In asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.

Handa VL, Zyczynski HM, Burgio KL, Fitzgerald MP, Borello-France D, Janz NK, Fine PM, Whitehead W, Brown MB, Weber AM (2007) The impact of fecal and urinary incontinence on quality of life 6 months after childbirth. Am J Obstet Gynecol 197:636e1–636e6

Whitehead WE (2002) Fecal incontinence: a neglected area of gastroenterology. Gastroenterology 122:5PubMedCrossRef

DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101:46–53PubMedCrossRef

Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712PubMedCrossRef

Borello-France D, Burgio KL, Richter HE, Zyczynski H, Fitzgerald MP, Whitehead W, Fine P, Nygaard I, Handa VL, Visco AG, Weber AM, Brown MB (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872PubMedCrossRef

Weinstein MM, Pretorius DH, Jung SA, Nager CW, Mittal RK (2009) Transperineal three-dimensional ultrasound imaging for detection of anatomic defects in the anal sphincter complex muscles. Clin Gastroenterol Hepatol 7:205–211PubMedCrossRef

Bharucha AE (2003) Fecal incontinence. Gastroenterology 124:1672–1685PubMedCrossRef

Fernandez-Fraga X, Azpiroz F, Malagelada JR (2002) Significance of pelvic floor muscles in anal incontinence. Gastroenterology 123:1441–1450PubMedCrossRef

Jung SA, Pretorius DH, Padda BS, Weinstein MM, Nager CW, den Boer DJ, Mittal RK (2007) Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol 197:52e1–52e7CrossRef

10.

Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G, Mittal RK (2005) Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol 106:774–781PubMedCrossRef

11.

Guaderrama NM, Nager CW, Liu J, Pretorius DH, Mittal RK (2005) The vaginal pressure profile. Neurourol Urodyn 24:243–247PubMedCrossRef

12.

Padda BS, Jung SA, Pretorius D, Nager CW, Den-Boer D, Mittal RK (2007) Effects of pelvic floor muscle contraction on anal canal pressure. Am J Physiol Gastrointest Liver Physiol 292:G565–G571PubMedCrossRef

13.

Raizada V, Mittal RK (2008) Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am 37:493–509PubMedCrossRef

14.

Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14:131–139PubMedCrossRef

15.

Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: The Fecal Incontinence Severity Index. Dis Colon Rectum 42:1525–1532PubMedCrossRef

16.

Weinstein MM, Jung SA, Pretorius DH, Nager CW, den Boer DJ, Mittal RK (2007) The reliability of puborectalis muscle measurements with 3-dimensional ultrasound imaging. Am J Obstet Gynecol 197:68e1–68e6CrossRef

17.

Lee JH, Pretorius DH, Weinstein M et al (2007) Transperineal three-dimensional ultrasound in evaluating anal sphincter muscles. Ultrasound Obstet Gynecol 30(2):201–209PubMedCrossRef

18.

Dent J (1976) A new technique for continuous sphincter pressure measurement. Gastroenterology 71:263–267PubMed

19.

Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMedCrossRef

20.

Oberwalder M, Connor J, Wexner SD (2003) Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 90:1333–1337PubMedCrossRef

21.

Valsky DV, Messing B, Petkova R, Savchev S, Rosenak D, Hochner-Celnikier D, Yagel S (2007) Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique. Ultrasound Obstet Gynecol 29:195–204PubMedCrossRef

22.

Bharucha AE, Fletcher JG, Harper CM, Hough D, Daube JR, Stevens C, Seide B, Riederer SJ, Zinsmeister AR (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut 54:546–555PubMedCrossRef

23.

Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct 19:633–636PubMedCrossRef

24.

Dumoulin C, Gravel D, Bourbonnais D, Lemieux MC, Morin M (2004) Reliability of dynamometric measurements of the pelvic floor musculature. Neurourol Urodyn 23:134–142PubMedCrossRef

25.

DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, Hussain H, Umek W, Hsu Y, Ashton-Miller JA (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302PubMedCrossRef

26.

Verelst M, Leivseth G (2004) Force–length relationship in the pelvic floor muscles under transverse vaginal distension: a method study in healthy women. Neurourol Urodyn 23:662–667PubMedCrossRef

27.

Rajasekaran MR, Jiang Y, Bhargava V, Littlefield R, Lee A, Lieber RL, Mittal RK (2008) Length–tension relationship of the external anal sphincter muscle: implications for the anal canal function. Am J Physiol Gastrointest Liver Physiol 295:G367–G373PubMedCrossRef

Titel: Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women
verfasst von: Milena M. Weinstein
Dolores H. Pretorius
Sung-Ae Jung
Jennifer J. Wan
Charles W. Nager
Ravinder K. Mittal
Publikationsdatum: 01.09.2011
Verlag: Springer-Verlag
Erschienen in: International Urogynecology Journal / Ausgabe 9/2011
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-011-1446-8

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Nodal-negativ nach neoadjuvanter Chemo: Axilladissektion verzichtbar?

03.05.2024 Mammakarzinom Nachrichten

Wenn bei Mammakarzinomen durch eine neoadjuvante Chemotherapie ein Downstaging von nodal-positiv zu nodal-negativ gelingt, scheint es auch ohne Axilladissektion nur selten zu axillären Rezidiven zu kommen.

Rezidivierender Peritonsillarabszess nach Oralsex

02.05.2024 Peritonsillarabszess Kasuistik

Die erotischen Dimensionen von Peritonsillarabszessen scheinen eng begrenzt zu sein. Das heißt aber nicht, solche Abszesse und Erotik hätten nichts miteinander gemein, wie ein Fallbericht verdeutlicht.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women