Anal sphincter damage after vaginal delivery: relationship of anal endosonography and manometry to anorectal complaints.
OBJECTIVE
This study was designed to assess the relationship of anal endosonography and manometry to anorectal complaints in the evaluation of females a long time after vaginal delivery complicated by anal sphincter damage.


METHODS
Thirty-four patients with anal sphincter damage after delivery, 22 with and 12 without anorectal complaints, and 12 controls without anorectal complaints underwent anal endosonography, manometry, and rectal sensitivity testing. Complaints were assessed by questionnaire, with a median follow-up of 19 years.


RESULTS
Median maximum anal resting pressures were significantly lower in patients with anal sphincter damage with complaints (31 mmHg) than in controls (52 mmHg; P < 0.001). Median maximum anal squeeze pressures were significantly lower in patients with (55 mmHg) and without (69 mmHg) complaints than in controls (112 mmHg; P < 0.001 for both). Maximum anal resting pressures were significantly lower in patients with anorectal complaints after anal sphincter damage than in patients without complaints (P = 0.02). Results of anal manometry showed a large overlap between all groups. Rectal sensitivity showed no significant differences between the three groups. Persisting sphincter defects, shown by anal endosonography, were significantly more present in patients with anal sphincter damage after delivery with (86 percent) and without (67 percent) complaints than in controls (8 percent; P < 0.001 and P < 0.01, respectively). No differences in the number of echocardiographically proven sphincter defects were found between patients with or without anorectal complaints after anal sphincter damage


CONCLUSIONS
Echographically proven sphincter defects are strongly associated with a history of anal sphincter damage during delivery. Sphincter defects are present in the majority of patients with anorectal complaints. Anal manometry provides little additional therapeutic information when performed after anal endosonography in patients with anorectal complaints after anal sphincter damage during delivery.
Department of Obstetrics and Gynecology, Ikazia Hospital, Rotterdam, The Netherlands.
Jan-Willem
JW
de Leeuw
Mark E
ME
Vierhout
Piet C
PC
Struijk
Hajo J
HJ
Auwerda
Dirk-Jan
DJ
Bac
Henk C S
HC
Wallenburg
D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology* / Q000601:surgery; D036861:Delivery, Obstetric / Q000009:adverse effects*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008365:Manometry; D011312:Pressure; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires