title: Usefulness of anorectal and endovaginal 3D ultrasound in the evaluation of sphincter and pubovisceral muscle defects using a new scoring system in women with fecal incontinence after vaginal delivery.
abstract: OBJECTIVE
  This study aims to evaluate pubovisceral muscle and anal sphincter defects in women with previous vaginal delivery and fecal incontinence and to correlate the findings with the severity of symptoms using the combined anorectal and endovaginal 3D ultrasonography with a new ultrasound scoring system.
  
  
  METHODS
  Consecutive female patients with previous vaginal delivery and fecal incontinence symptoms were screened. Fecal incontinence was assessed with the Cleveland Clinic Florida fecal incontinence scale, and the extent of defects was assessed by an ultrasound score based on results of anorectal and endovaginal 3D ultrasound. Fecal incontinence was assessed with the Cleveland Clinic Florida fecal incontinence scale.
  
  
  RESULTS
  Of 84 women with previous vaginal delivery and fecal incontinence, 21 (25%) had intact pubovisceral muscles and anal sphincters; 63 (75%) had a pubovisceral muscle or anal sphincter defect, or both. Twenty-eight (33%) had a pubovisceral muscle defect [23% with an external anal sphincter (EAS) defect or combined EAS/internal anal sphincter defects; 11% with intact anal sphincters]. Thirty-five (42%) had intact pubovisceral muscles and an anal sphincter defect. Compared with women with intact pubovisceral muscles/anal sphincter defects, patients with pubovisceral muscle defects had significantly higher incontinence scores and significantly higher ultrasound scores indicating more extensive defects. Incontinence symptoms correlated positively with the ultrasound score, measurements of sphincter defects, and area of the levator hiatus.
  
  
  CONCLUSIONS
  Evaluation of both pubovisceral muscles and anal sphincters is important to identify defects and determine treatment for women with fecal incontinence after vaginal delivery. The severity of fecal incontinence symptoms is significantly related to the extent of defects of the pubovisceral muscles and anal sphincters.
authors.affiliation: Department of Surgery, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil. smregadas@hospitalsaocarlos.com.br.|Department of Surgery, Unit of Pelvic Floor and Anorectal Physiology, School of Medicine, Clinical Hospital, Federal University of Ceará, Av Pontes Vieira, 2551, Fortaleza, Ceará, 60130-241, Brazil. smregadas@hospitalsaocarlos.com.br.|Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil. smregadas@hospitalsaocarlos.com.br.
authors.forename: Sthela M
authors.initials: SM
authors.lastname: Murad-Regadas
authors.affiliation: Department of Surgery, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Graziela Olivia
authors.initials: GO
authors.lastname: da S Fernandes
authors.affiliation: Department of Surgery, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil.
authors.forename: Francisco Sergio Pinheiro
authors.initials: FS
authors.lastname: Regadas
authors.affiliation: Department of Surgery, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil.
authors.forename: Lusmar Veras
authors.initials: LV
authors.lastname: Rodrigues
authors.affiliation: Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil.
authors.forename: Francisco Sergio Pinheiro Regadas
authors.initials: FS
authors.lastname: Filho
authors.affiliation: Department of Surgery, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Iris Daiana
authors.initials: ID
authors.lastname: Dealcanfreitas
authors.affiliation: Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil.
authors.forename: Adjra
authors.initials: A
authors.lastname: da Silva Vilarinho
authors.affiliation: Unit of Pelvic Floor and Anorectal Physiology, Department of Colorectal Surgery, Sao Carlos Hospital, Fortaleza, Ceará, Brazil.
authors.forename: Mariana Murad
authors.initials: MM
authors.lastname: da Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000473:pathology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D009132:Muscles / Q000473:pathology*; D017773:Pelvic Floor / Q000473:pathology; D015995:Prevalence; D012007:Rectum / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Imaging; Incontinence; Pelvic floor; Physiology; Ultrasound