title: Do changes in anal sphincter anatomy correlate with anal function in women with a history of vaginal delivery?
abstract: OBJECTIVE
  To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function.
  
  
  METHODS
  Female with fecal incontinence and vaginal delivery were assessed with Wexner's score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score.
  
  
  RESULTS
  Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects.
  
  
  CONCLUSIONS
  Fecal incontinence symptoms did not correlate with anal pressures and anal sphincter anatomy changes, but women with sphincter defects have shorter anterior EAS and IAS and a longer gap.
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Sthela Maria
authors.initials: SM
authors.lastname: Murad-Regadas
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Iris Daiana
authors.initials: ID
authors.lastname: Dealcanfreitas
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Francisco Sergio Pinheiro
authors.initials: FS
authors.lastname: Regadas
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Lusmar Veras
authors.initials: LV
authors.lastname: Rodrigues
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Graziela Olivia da Silva
authors.initials: GO
authors.lastname: Fernandes
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Jacyara de Jesus Rosa
authors.initials: Jde J
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D019160:Endosonography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008365:Manometry; D008875:Middle Aged