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The relationship of 3-D translabial ultrasound anal sphincter complex measurements to postpartum anal and fecal incontinence

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Abstract

Introduction and hypothesis

We aimed to determine whether anal sphincter complex (ASC) measurements on translabial ultrasound (TL-US) were related to anal incontinence (AI) or fecal incontinence (FI) symptoms 6 months postpartum.

Methods

A prospective cohort of primiparous women underwent TL-US 6 months after a vaginal birth (VB) or cesarean delivery (CD). Muscle thickness was measured at 3, 6, 9, and 12 o’clock positions of the external anal sphincter (EAS), the same four quadrants of the internal anal sphincter (IAS) at proximal, mid, and distal levels, and at the bilateral pubovisceralis muscle (PVM). Measurements were correlated to AI and FI on the Wexner Fecal Incontinence Scale, with sub-analyses by mode of delivery. The odds ratio (OR) of symptoms was calculated for every 1 mm increase in muscle thickness (E1MIT).

Results

A total of 423 women (299 VB, 124 CD) had TL-US 6 months postpartum. Decreased AI risk was associated with thicker measurements at the 6 o’clock (OR 0.74 E1MIT) and 9 o’clock proximal IAS (OR 0.71 E1MIT) in the entire cohort. For CD women, thicker measurements of the 9 o’clock proximal IAS were associated with decreased risk of AI (OR 0.56 E1MIT) and thicker distal 6 o’clock IAS measurements were related to a decreased risk of FI (OR 0.37 E1MIT). For VB women, no sphincter measurements were significantly related to symptoms, but thicker PVM measurements were associated with increased risk of AI (right side OR 1.32 E1MIT; left side OR 1.21 E1MIT).

Conclusions

ASC anatomy is associated with AI and FI in certain locations; these locations vary based on the patient’s mode of delivery.

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Conflicts of interest

K.V. Meriwether, R.J. Hall, L.M. Leeman, L. Migliaccio, and C. Qualls have no conflicts of interest to disclose. R.G. Rogers is Chair DSMB for the Transform trial sponsored by American Medical Systems.

Authors’ contributions

K.V. Meriwether: data analysis, manuscript writing; R.J. Hall: study development, data collection/management, manuscript editing; L.M. Leeman: protocol/project development, data collection/management, manuscript editing; L. Migliaccio: protocol/project development, manuscript editing; C. Qualls: data analysis, manuscript editing; R.G. Rogers: protocol/project development, data collection/management, manuscript editing.

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Authors and Affiliations

  1. University of New Mexico, Albuquerque, NM, USA

    Kate V. Meriwether, Rebecca J. Hall, Lawrence M. Leeman, Laura Migliaccio, Clifford Qualls & Rebecca G. Rogers

  2. Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, USA

    Kate V. Meriwether

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  1. Kate V. Meriwether
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  2. Rebecca J. Hall
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  3. Lawrence M. Leeman
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  4. Laura Migliaccio
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  5. Clifford Qualls
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  6. Rebecca G. Rogers
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Correspondence to Kate V. Meriwether.

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Meriwether, K.V., Hall, R.J., Leeman, L.M. et al. The relationship of 3-D translabial ultrasound anal sphincter complex measurements to postpartum anal and fecal incontinence. Int Urogynecol J 26, 1191–1199 (2015). https://doi.org/10.1007/s00192-015-2676-y

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  • DOI: https://doi.org/10.1007/s00192-015-2676-y

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