ENDOSONOGRAPHY OF THE ANAL SPHINCTERS - INCONTINENT AND CONTINENT PATIENTS AND HEALTHY CONTROLS

It has previously been shown that in healthy subjects anal sphincter f unctions as assessed by anorectal manomentry and anal sphincter anatom y as measured by endoluminal ultrasound are poorly correlated. It rema ins to be shown, however, whether this is true for a larger series of patients with anorectal dysfunctions such as incontinence, and what is the clinical relevance of anal sonography. Anal sonography was perfor med in 42 consecutive patients with fecal incontinence, in 19 patients with constipation and/or anal pain, and in 15 healthy volunteers to d etermine anal sphincter integrity and the dorsal diameter of the inter nal and external anal sphincter muscles. Conventional multilumen anore ctal manometry was performed in all subjects and patients to determine , among others, external and internal sphincter (EAS, IAS) performance at rest and during squeezing. It was shown that healthy subjects exhi bit significantly higher muscle diameters of the IAS than both patient groups, but the EAS was similar in all groups. In 11/42 cases of inco ntinent patients, in 3/19 constipated patients, but in none of the con trols a muscle defect of the EAS was found with sonography. Thirteen o f these 14 patients were women with previous birth traumas. EAS but no t IAS muscle thickness and muscle performance (squeezing and resting, respectively) were significantly correlated. Across all groups, women had smaller EAS muscle diameters than men. It is concluded, that in in continent patients anal sonography may reveal additional information o f clinical relevance in a substantial fraction of patients, and, thus, both anal manometry and anal ultrasound are of clinical value.