title: Female anal sphincter: age-related differences in asymptomatic volunteers with high-frequency endoanal US.
abstract: OBJECTIVE
  To evaluate endoanal ultrasonographic (US) anatomy in a large group of nulliparous women by using a high-frequency 10-MHz transducer to define normal age-related differences in sphincter morphology.
  
  
  METHODS
  One hundred fifty asymptomatic nulliparous women (mean age, 31 years; range, 19-80 years) underwent endoanal US with a high-frequency 10-MHz transducer. Anal canal structures were measured at high, middle, and low levels and were correlated with age by using the Pearson simple linear correlation coefficient.
  
  
  RESULTS
  Internal sphincter thickness showed a highly significant positive correlation with age at both sites at which it was measured (high anal canal, r = 0.34, P <.001; middle anal canal, r = 0.33, P <.001). External sphincter thickness showed a highly significant negative correlation with age at all sites measured (high anal canal, r = -0.65, P <.001; middle anal canal, r = -0.49, P <.001; low anal canal, r = -0.21, P =.012). There was no significant correlation between age and thickness of subepithelial tissue, longitudinal muscle, or puborectalis muscle. Subjects whose internal sphincter showed mixed echogenicity were significantly older than those whose internal sphincter was uniformly hypoechoic (mean, 47.4 vs 34.6 years; P <.001). Subjects with mixed internal sphincter echogenicity also had a significantly thinner external sphincter at high (mean thickness, 3.8 vs 4.6 mm; P <.001) and middle (mean thickness, 3.7 vs 4.1 mm; P =.03) anal canal levels.
  
  
  CONCLUSIONS
  At older ages there are increased internal anal sphincter thickness and decreased external anal sphincter thickness. Diagnosis of external sphincter atrophy on the basis of sphincter thinning requires that one distinguish between abnormal thinning and age-related differences.
authors.affiliation: Intestinal Imaging Centre, St Mark's Hospital, Level 4V, Northwick Park, Watford Rd, Harrow, London HA1 3UJ, England.
authors.forename: Andrea
authors.initials: A
authors.lastname: Frudinger
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.forename: Clive I
authors.initials: CI
authors.lastname: Bartram
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Price
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kamm
authors.forename: Raimund
authors.initials: R
authors.lastname: Winter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D001003:Anal Canal / Q000000981:diagnostic imaging*; D015992:Body Mass Index; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D012016:Reference Values