VAGINAL ENDOSONOGRAPHY OF THE ANAL-SPHINCTER COMPLEX IS IMPORTANT IN THE ASSESSMENT OF FECAL INCONTINENCE AND PERIANAL SEPSIS

Background Anal endosonography is an established technique in the eval uation of anorectal disease. However, it is sometimes difficult to vis ualize the anterior part of the sphincter complex and anal endosonogra phy may be impossible when anal pain or stenosis is present. The aim o f this study was to evaluate vaginal endosonography in the diagnosis o f faecal incontinence and perianal sepsis. Methods Anal and vaginal en dosonography were performed in 56 women with faecal incontinence (n = 36) or perianal sepsis (n = 20). The technique and pelvic floor anatom y were described, anal sphincter measurements with anal and vaginal en dosonography were compared, and the additive value of vaginal over ana l endosonography in the diagnosis of faecal incontinence and perianal sepsis was assessed. Results The pelvic floor was clearly imaged with vaginal endosonography. However, after a relatively short learning cur ve it was still not possible to image the anal sphincters in three of 28 patients. Except for external anal sphincter thickness, which was s ignificantly lower, all anal canal structure measurements were greater with vaginal than with anal endosonography. Concerning the diagnosis of either faecal incontinence or perianal sepsis, vaginal endosonograp hy added important information in comparison with anal endosonography in 14 (25 per cent) of 56 patients. Conclusion Vaginal endosonography provides reliable images of the anal sphincters in an undistorted fash ion, thereby increasing the diagnostic yield of faecal incontinence an d perianal sepsis in 25 per cent of patients. Therefore, endosonograph ists should become acquainted with this technique.