Postdelivery anal function in primiparous females - Ultrasound and manometric study

PURPOSE: A study was performed to evaluate the early morphologic and functi onal consequences of vaginal delivery on the anal sphincter in primiparous females. METHODS, Among a cohort of 197 primiparous females who agreed to p articipate in a clinical evaluation of fecal incontinence and in a transana l ultrasound examination 12 weeks after delivery, 52 also underwent anal ma nometry using a radial six-port catheter, of whom 10 were asymptomatic and had a normal sphincter at ultrasound and the remaining 42 had clinical sign s of anal incontinence or ultrasonographic defects of the anal sphincter or both. Anal sphincter pressures and asymmetry index were analyzed at rest a nd during voluntary squeeze. Manometric and ultrasound results were compare d, together with clinical symptoms. RESULTS: Fourteen patients with clinica l signs of anal incontinence had lower resting and squeeze anal pressures t han continent patients (P < 0.05), but similar anal asymmetry indexes. Pati ents with incontinence and an anal defect had the lowest resting and squeez e anal pressures (P < 0.05). Forceps assistance to delivery was not associa ted with a higher frequency of anal sphincter lesions. Resting and squeeze anal pressures were lower in the forceps group (P < 0.005), but anal asymme try indexes were similar. Finally, manometric results were identical in the presence or absence of anal sphincter endosonographic defects. CONCLUSIONS : Anal sphincter defects are frequent after the first vaginal delivery, but are not always associated with functional or clinical abnormalities. Resti ng and squeeze anal pressures were significantly decreased in patients with incontinence and an anal defect and after forceps-assisted deliveries. Ana l asymmetry index was not found useful in this population of young primipar ous females.