Manometric diagnosis of anal sphincter injuries

Creighton University, Omaha, Nebraska, United States
The American Journal of Surgery (Impact Factor: 2.29). 02/1990; 159(1):112-6; discussion 116-7. DOI: 10.1016/S0002-9610(05)80615-4
Source: PubMed


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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    • "Resting pressure as basic manometric parameter has, however, a restriction that it represents cross sectional status of the anal canal without considering dimensional structure. Therefore, advanced parameters which can reflect dimensional pressure distribution such as vector volume, radial asymmetry,13,14 and RPG of the anal canal are devised. "
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    ABSTRACT: Gradient of resting pressure across the anal canal, which is known to have a role in continence mechanism, has 2 components of determination; pressure and length factor of the anal canal. This study evaluates which factor between them plays more significant role for the determination of the gradient in association with continence function. Anal manometric measurements of 69 patients with fecal incontinence and 60 controls were retrospectively reviewed. In addition to resting pressure gradient, typical manometric parameters such as maximum resting pressure, basal resting pressure, length of the anal canal, length of high pressure zone and relative position of highest pressure, which were measured with rapid pull-through technique were all contrasted. Demographics of the 2 groups were similar. Maximum resting pressures of patients with incontinence and controls were 59.1 ± 28.3, 74.6 ± 24.0 mmHg (P = 0.001), respectively. Basal resting pressures were 5.7 ± 6.4 and 7.3 ± 3.9 mmHg (P = 0.097), lengths of the anal canal were 35.8 ± 9.1 and 38.1 ± 8.3 mm (P = 0.133), lengths of high pressure zone were 21.2 ± 6.7 and 23.3 ± 6.5 mm (P = 0.091), relative positions of highest pressure were 69.2 ± 10.6 and 70.1% ± 14.9% (P = 0.717) and resting pressure gradients were 2.28 ± 1.08 and 2.74 ± 1.14 mmHg/mm (P = 0.019), respectively. Difference was significant in maximum resting pressure and resting pressure gradient, but not in length factors such as full length of the anal canal, length of high pressure zone and relative position of highest pressure. Proximal location of high pressure zone in incontinent patients is not definite and resting pressure gradient of the anal canal depends more on pressure factor than length factor in association with continence function.
    Full-text · Article · Jul 2011 · Journal of neurogastroenterology and motility
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    ABSTRACT: Continence depends on a number of factors that include stool consistency, the capacity of the sigmoid colon to retard progress of stool, the compliance and sensation of urgency of the rectum, phasic contractions of the puborectalis muscle to form a normal anorectal angle, a normal internal (IAS) and external anal sphincter (EAS) function, and normal sensation in the anal canal [1–3].
    No preview · Article · Jan 2010
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