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 18 January 2018

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Evaluating anal sphincter damage after delivery with anal endosonography and manometry

Anal manometry provides little additional therapeutic information when performed after anal endosonography in females with anorectal complaints after anal sphincter damage during vaginal delivery, finds research published in August's Diseases of the Colon & Rectum.

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Researchers from Rotterdam, the Netherlands, investigated anal sphincter damage after vaginal delivery.

They assessed the relationship of anal endosonography and manometry to anorectal complaints in the evaluation of females.

A total of 34 patients with anal sphincter damage after delivery - 22 with and 12 without anorectal complaints - were included in the study.

A further 12 controls without anorectal complaints were enrolled.

All underwent anal endosonography, manometry, and rectal sensitivity testing.

Complaints were assessed by questionnaire, with a median follow-up of 19 years.

Sphincter defects present in majority of patients with anorectal complaints.
Diseases of the Colon & Rectum
The team found that median maximum anal resting pressures were significantly lower in patients with anal sphincter damage with complaints (31 mmHg) than in controls (52 mmHg).

Median maximum anal squeeze pressures were also significantly lower in patients with (55 mmHg) and without (69 mmHg) complaints than in controls (112 mmHg).

Furthermore, maximum anal resting pressures were significantly lower in patients with anorectal complaints after anal sphincter damage than in patients without complaints.

Results of anal manometry showed a large overlap between all groups.

There were no significant differences in rectal sensitivity between the 3 groups.

Persisting sphincter defects, shown by anal endosonography, were significantly more prevalent in patients with anal sphincter damage after delivery with (86%) and without (67%) complaints than in controls (8%).

However, no differences in the number of echocardiographically proven sphincter defects were found between patients with or without anorectal complaints after anal sphincter damage

Author Jan-Willem de Leeuw, of the Ikazia Hospital, said on behalf of the group, "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," it was concluded.

Dis Colon Rectum 2002; 45 (8): 1004-10
21 August 2002

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