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      Does correlation exist between anorectal manometry and endoanal ultrasound findings in healthy subjects according to age? Translated title: ¿Existe correlación entre la manometría anorrectal y los datos de la ecografía endoanal en sujetos sanos en función de la edad?

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          Abstract

          Background: different studies have demonstrated the correlation between anorectal manometry and endoanal ultrasonography data in patients with fecal incontinence, but there is no almost interest describing the same in healthy subjects according to age. Aims: to study the possible correlation between anorectal manometry and endoanal ultrasonography data in a homogeneous group of healthy women, also according to age. Material and methods: prospective observational study of a healthy subjects cohort (n = 14). Homogeneous group of healthy volunteer women divided in 2 subgroups according to age. Results: there was no proved correlation between the internal anal sphincter's measurement and the resting pressure in the whole sample as well as the analysis according to age. Neither there was any proved statistically significant correlation between the external anal sphincter's thickness and the squeeze pressure, in the whole sample and by groups. Conclusions: it does not exist statistically significant correlation between the thickness of the sphincters and its function in a healthy subjects homogeneous group, neither in 2 groups according to age.

          Translated abstract

          Introducción: diferentes estudios han demostrado la correlación entre los datos de la manometría anorrectal y la ecografía endoanal en pacientes con incontinencia fecal, pero el interés ha sido escaso en describir lo mismo en sujetos sanos en relación a la edad. Objetivos: estudiar la posible correlación entre los datos de la manometría anorrectal y de la ecografía endoanal en un grupo homogéneo de mujeres sanas, también en función de la edad de las mismas. Material y métodos: estudio prospectivo observacional de una cohorte de sujetos sanos (n = 14). Grupo homogéneo de mujeres voluntarias sanas divididas en 2 subgrupos en función de la edad. Resultados: no se objetivó correlación entra la medida del esfínter anal interno y la presión basal de reposo, tanto en toda la muestra analizada como en el análisis detallado por grupos de edad. Tampoco se objetivó correlación estadísticamente significativa entre el grosor del esfínter anal externo y la presión de esfuerzo, en toda la muestra analizada y por grupos. Conclusiones: no existe correlación estadísticamente significativa entre el grosor de los esfínteres y su función en un grupo homogéneo de sujetos sanos, tampoco en función de 2 grupos de edad.

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          Most cited references41

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          Obstetric anal sphincter injury: incidence, risk factors, and management.

          Obstetric sphincter damage is the most common cause of fecal incontinence in women. This review aimed to survey the literature, and reach a consensus, on its incidence, risk factors, and management. This systematic review identified relevant studies from the following sources: Medline, Cochrane database, cross referencing from identified articles, conference abstracts and proceedings, and guidelines published by the National Institute of Clinical Excellence (United Kingdom), Royal College of Obstetricians and Gynaecologists (United Kingdom), and American College of Obstetricians and Gynecologists. A total of 451 articles and abstracts were reviewed. There was a wide variation in the reported incidence of anal sphincter muscle injury from childbirth, with the true incidence likely to be approximately 11% of postpartum women. Risk factors for injury included instrumental delivery, prolonged second stage of labor, birth weight greater than 4 kg, fetal occipitoposterior presentation, and episiotomy. First vaginal delivery, induction of labor, epidural anesthesia, early pushing, and active restraint of the fetal head during delivery may be associated with an increased risk of sphincter trauma. The majority of sphincter tears can be identified clinically by a suitably trained clinician. In those with recognized tears at the time of delivery repair should be performed using long-term absorbable sutures. Patients presenting later with fecal incontinence may be managed successfully using antidiarrheal drugs and biofeedback. In those who fail conservative treatment, and who have a substantial sphincter disruption, elective repair may be attempted. The results of primary and elective repair may deteriorate with time. Sacral nerve stimulation may be an appropriate alternative treatment modality. Obstetric anal sphincter damage, and related fecal incontinence, are common. Risk factors for such trauma are well recognized, and should allow for reduction of injury by proactive management. Improved classification, recognition, and follow-up of at-risk patients should facilitate improved outcome. Further studies are required to determine optimal long-term management.
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            Anal canal anatomy showed by three-dimensional anorectal ultrasonography.

            Demonstrate precisely the anatomic configuration of the anal canal and the length and thickness of the anal sphincters using three-dimensional (3-D) anorectal ultra-sonography in both genders. Twelve normal volunteer males and 14 females, with a mean age of 52.4 and 50.3 years, respectively, were prospectively enrolled in this study. All individuals from both groups were submitted to anorectal ultra-sonography. The anal canal was analyzed, measuring the length and thickness of the external anal sphincter (EAE), internal anal sphincter (IAS), puborectalis muscle (PR) and the gap (distance from the anterior EAS to the anorectal junction) in the midline longitudinal (ML) and transverse (MT) planes, and the results were compared between quadrants and genders. The distribution of sphincter muscles is asymmetric in both genders. The anterior upper anal canal is an extension of the rectal wall with all layers clearly identified. The anterior IAS is formed in the distal upper anal canal and is significantly shorter in female than in male in all quadrants. The anterior IAS length is shorter than the posterior and lateral in both genders. The anterior EAS length is significantly shorter (2.2 cm) and the gap is longer (1.2 cm) in female than in male (3.4 cm) (0.7 cm) (p < 0.05), respectively. The posterior and lateral EAS-PR is significant longer in males (3.6 cm) (3.9 cm) than in females (3.2 cm) (3.5 cm) (p < 0.05), respectively. The lateral EAS-PR is significant longer than the posterior part in both genders. The anterior IAS is significantly thicker in males (0.19 cm) than in females (0.12 cm) (p = 0.04). 3-D anal endosonography enabled measurement of the different anatomical structures of the anal canal and demonstrated its asymmetrical configuration. The shorter anterior EAS and IAS associated with a longer gap could justify the higher incidence of pelvic floor dysfunction in females, especially fecal incontinence and anorectocele with rectal intussusception.
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              Effect of aging on anorectal and pelvic floor functions in females.

              In females, fecal incontinence often is attributed to birth trauma; however, symptoms sometimes begin decades after delivery, suggesting that anorectal sensorimotor functions decline with aging. In 61 asymptomatic females (age, 44 +/- 2 years, mean +/- standard error of the mean) without risk factors for anorectal trauma, anal pressures, rectal compliance, and sensation were assessed by manometry, staircase balloon distention, and a visual analog scale during phasic distentions respectively. Anal sphincter appearance and pelvic floor motion also were assessed by static and dynamic magnetic resonance imaging respectively in 38 of 61 females. Aging was associated with lower anal resting (r = -0.44, P < 0.001) and squeeze pressures (r = -0.32, P = 0.01), reduced rectal compliance (i.e., r for pressure at half-maximum volume vs. age = 0.4, P = 0.001), and lower (P
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                diges
                Revista Española de Enfermedades Digestivas
                Rev. esp. enferm. dig.
                Sociedad Española de Patología Digestiva (Madrid )
                1130-0108
                June 2011
                : 103
                : 6
                : 304-309
                Affiliations
                [1 ] Parc Sanitari Sant Joan de Déu Spain
                [2 ] Parc Sanitari Sant Joan de Déu Spain
                [3 ] Parc Sanitari Sant Joan de Déu Spain
                Article
                S1130-01082011000600005
                10.4321/S1130-01082011000600005
                a9b5b45c-533d-437f-b642-7f0bdd07282a

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                GASTROENTEROLOGY & HEPATOLOGY

                Gastroenterology & Hepatology
                Anorectal manometry,Endoanal ultrasonography,Healthy volunteers,Fecal incontinence,Manometría anorrectal,Ecografía endoanal,Voluntarias sanas,Incontinencia fecal

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