title: Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence.
abstract: BACKGROUND
  Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence.
  
  
  METHODS
  44 patients, (42 women, mean age: 64 (11) years), complaining of anal incontinence, underwent anal vector manometry, endo-anal ultrasonography (to assess sphincter defects) and pelvic viscerogram (for the diagnosis of rectal prolapse). Resting and squeeze anal pressures, and anal asymmetry index at rest and during voluntary squeeze were determined by vector manometry.
  
  
  RESULTS
  Ultrasonography identified 19 anal sphincter defects; there were 9 cases of overt rectal prolapse, and 14 other cases revealed by pelvic viscerogram (recto-anal intussuception). Patients with rectal prolapse had a significantly higher anal sphincter asymmetry index at rest, whether patients with anal sphincter defects were included in the analysis or not (30 (3) % versus 20 (2) %, p < 0.005). Among patients without rectal prolapse, a higher anal sphincter asymmetry index during squeezing was found in patients with anal sphincter defects (27 (2) % versus 19 (2) %, p < 0.03).
  
  
  CONCLUSIONS
  In anal incontinent patients, anal asymmetry index may be increased in case of anal sphincter defect and/or rectal prolapse. In the absence of anal sphincter defect at ultrasonogaphy, an increased anal asymmetry index at rest may point to the presence of a rectal prolapse.
authors.affiliation: Fédération des Spécialités Digestives, Hôpital E. Herriot, 69437 Lyon cedex 03, France. henri.damon@wanadoo.fr
authors.forename: Henri
authors.initials: H
authors.lastname: Damon
authors.forename: Luc
authors.initials: L
authors.lastname: Henry
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.forename: Xavier
authors.initials: X
authors.lastname: Barth
authors.forename: François
authors.initials: F
authors.lastname: Mion
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012005:Rectal Prolapse / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D014463:Ultrasonography