Manometric diagnosis of anal sphincter injuries.
ABSTRACT A manometric technique of anal pressure vectography has been developed for the detection of anal sphincter injuries. Manometric symmetry of the anal sphincter can be visualized on the pressure vectorgram and quantified as a vector symmetry index. The mean vector symmetry index in asymptomatic women was 0.76, compared with 0.33 in incontinent women with a known sphincter injury (p = 0.0001). Among women who were incontinent without having a recognized sphincter injury, nearly half of those who had a previous episiotomy had subnormal (less than 0.60) vector symmetry indices (p = 0.0003). The values were in the same range as those from known injuries, suggesting the presence of an occult sphincter injury. In contrast, normal symmetry indices were found in all those who had never had an episiotomy or who presented with outlet constipation. We conclude that the vector symmetry index can expose occult anal sphincter injuries and may have a role in the selection of patients for sphincter repair.
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ABSTRACT: Anorectal manometry is used extensively in the assessment of patients with disorders of the pelvic floor. The present study investigated the repeatability of anorectal manometry in healthy volunteers and patients. A total of 30 healthy volunteers (15 men and 15 women) and 10 patients with fecal incontinence (4 men and 6 women) underwent perfusion manometry and volumetry. Intraindividual variability was evaluated using the intraindividual correlation coefficient (ICC). Interindividual variability was expressed as the standard deviation from the calculated mean values. We found a high intraindividual correlation for the squeezing pressure (ICC 0.75-0.95), vector volume (ICC 0.88-0.97), and rectal perception (ICC 0.82-0.98). The anal resting pressure showed moderate repeatability (ICC 0.60-0.72). However, with regard to sphincter asymmetry, rectal compliance, and the rectoanal inhibitory reflex, a wide range of variability was found. In the female volunteers, the squeezing pressure and vector volume were lower than in those in the male volunteers. The anal pressure, vector volume, thresholds for urgency, and the maximum tolerable volume were lower in the incontinent patients than in the healthy volunteers. The squeezing pressure, vector volume, and rectal perception allow a reliable analysis of anal sphincter function. Sphincter asymmetry, rectal compliance, and the rectoanal inhibitory reflex were of limited diagnostic value.Journal of Surgical Research 06/2013; 185(2). DOI:10.1016/j.jss.2013.06.008 · 2.12 Impact Factor