title: Measurement of anal cushions in continent women.
abstract: OBJECTIVE
  Anal cushions are connective tissue complexes thought to be involved in anal continence. This study aimed to assess them in continent subjects.
  
  
  METHODS
  Continent women undergoing a transvaginal ultrasound scan for gynaecological reasons were included. The anal cushions were visualized at the mid-canal level. The cross-sectional area within the internal anal sphincter (Area 1) and the area enclosed within the anal cushions (Area 2) were measured and a Cushion:Canal (C:C) ratio was derived for each patient. The measurements were repeated in the semi-erect position.
  
  
  RESULTS
  One hundred and two patients with a median age of 41 (IQR 32-49) years were included. The median C:C ratio was 0.68 (IQR 0.61-0.73). Inter-observer error was 0.98 and intra-observer error was 0.99. There was no significant correlation between age and C:C ratio. The C:C ratio was significantly higher in parous than in nulliparous women (P = 0.04). A history of obstetric trauma or minimal haemorrhoidal symptoms did not influence C:C ratio. There was a significant increase in C:C ratio in the erect position. (P = 0.04).
  
  
  CONCLUSIONS
  There was a wide range of variability in the measurement of anal cushions in normal continent women. These were not influenced by age.
authors.affiliation: John Goligher Colorectal Unit, The General Infirmary at Leeds, Leeds, UK.
authors.forename: D K
authors.initials: DK
authors.lastname: Thekkinkattil
authors.forename: R J
authors.initials: RJ
authors.lastname: Dunham
authors.forename: S
authors.initials: S
authors.lastname: O'Herlihy
authors.forename: P J
authors.initials: PJ
authors.lastname: Finan
authors.forename: P M
authors.initials: PM
authors.lastname: Sagar
authors.forename: D A
authors.initials: DA
authors.lastname: Burke
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D019160:Endosonography; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011187:Posture; D018709:Statistics, Nonparametric