Chakraborty, Sumit

AbstractBackgroundEndoanal MRI and MR defecography are used to identify anal sphincter injury and disordered defecation. However, few studies have evaluated findings in asymptomatic healthy people. The effects of BMI and parity on rectoanal motion and evacuation are unknown.MethodsIn 113 asymptomatic females (age 50 ± 17 years, Mean ± SD) without risk factors for anorectal trauma, anal sphincter appearance, anorectal motion, and pelvic organ prolapse were evaluated with MRI. The relationship between age, BMI, and parity and structural findings were evaluated with parametric and non‐parametric tests.ResultsThe anal sphincters and puborectalis appeared normal in over 90% of women. During dynamic MRI, the anorectal angle was 100 ± 1º (Mean ± SEM) at rest, 70 ± 2° at squeeze, and 120 ± 2° during defecation. The change in anorectal angle during squeeze (r = −.25, P < .005), but not during evacuation (r = .13, P = .25) was associated with age. In the multivariable models, BMI (P < .01) and parity (P < .01) were, respectively, independently associated with the intersubject variation in the anorectal angle at rest and the angle change during squeeze. Ten percent or fewer women had had descent of the bladder base or uterus 4 cm or more below the pubococcygeal line or a rectocele measuring 4 cm or larger. Only 5% had a patulous anal canal.ConclusionsIn addition to age, BMI and parity also affect anorectal motion in asymptomatic women. These findings provide age‐adjusted normal values for rectoanal anatomy and pelvic floor motion.

AbstractBackgroundWhile widely used in clinical practice, the reproducibility of high‐definition anorectal manometry (HD‐ARM) remains unclear. We evaluated the intra‐individual reproducibility of HD‐ARM and compared pressures measured with HD‐ARM and high‐resolution anorectal manometry (HR‐ARM).MethodsThirty‐six women with fecal incontinence had an initial HD‐ARM (HD‐ARM1); on the same day, after randomization, 21 had a second (HD‐ARM2). Sixteen women had a third (HD‐ARM3) 4 weeks later. Twenty‐five had also been evaluated by HR‐ARM previously. Rectoanal pressures were assessed at rest, during squeeze and simulated evacuation. Concordance among pressures was assessed with Lin's concordance correlation coefficient (CCC).Key ResultsAnal resting and squeeze pressures measured with HD‐ARM were reproducible on the same and different days; for average resting pressures of HD‐ARM1 vs HD‐ARM2, CCC = 0.73 (95% confidence interval [CI]: 0.53–0.94), and for HD‐ARM1 vs HD‐ARM3, CCC = 0.60 (95% CI: 0.28–0.93). For maximum squeeze pressures of HD‐ARM1 vs HD‐ARM2, CCC = 0.86 (95% CI: 0.75–0.97), and for HD‐ARM1 vs HD‐ARM3, CCC = 0.56 (95% CI: 0.21–0.91). The rectoanal gradient during evacuation was significantly concordant between HD‐ARM1 and HD‐ARM2 but not HD‐ARM1 and HD‐ARM3. Resting (CCC = 0.38 [95% CI: 0.14–0.62]) and squeeze pressures (CCC = 0.73 [95% CI: 0.57–0.89]) measured with HD‐ARM1 and HR‐ARM were also concordant.Conclusions & InferencesAmong women with fecal incontinence, measurements with HD‐ARM were reproducible on the same (anal resting and squeeze pressures and rectoanal gradient during evacuation) and different days (anal resting and squeeze pressures) and correlated with HR‐ARM measurements. These findings support use of HD‐ARM and HR‐ARM for longitudinal assessments of anal resting and squeeze pressures.