Impact of sex and aging on radiographic and functional parameters of the anal sphincter complex in patients with accidental bowel leakage

被引:1
作者
Artsen, Amanda M. [1 ,2 ]
Dyer, Keisha Y. [3 ]
Routzong, Megan R. [4 ]
Zazueta-Damian, Gisselle [3 ]
Weinstein, Milena M. [5 ]
Alperin, Marianna [4 ,6 ]
机构
[1] Univ Calif San Diego, Dept Obstet Gynecol & Reprod Sci, San Diego, CA 92093 USA
[2] Univ Pittsburgh, Magee Womens Res Inst, Pittsburgh, PA USA
[3] Kaiser Permanente, Dept Obstet & Gynecol, San Diego, CA USA
[4] Univ Calif San Diego, Dept Obstet Gynecol & Reprod Sci, Div Female Pelv Med & Reconstruct Surg, San Diego, CA 92093 USA
[5] Harvard SOM, Massachusetts Gen Hosp, Dept Obstet & Gynecol, Div Female Pelv Med & Reconstruct Surg, Boston, MA USA
[6] Univ Calif San Diego, 9500 Gilman Dr La Jolla, San Diego, CA 92093 USA
基金
美国国家卫生研究院;
关键词
accidental bowel leakage; aging; endoanal ultrasound; external anal sphincter; internal anal sphincter; puborectalis; sex differences; FECAL INCONTINENCE; ENDOANAL ULTRASONOGRAPHY; SARCOPENIA; AGE; ATROPHY; INJURY; GENDER;
D O I
10.1002/nau.25151
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
AimsTreatment outcomes for accidental bowel leakage (ABL) may be influenced by age-related sarcopenia. We sought to determine if thickness of the anal sphincter complex on endoanal ultrasound correlated with function in women and men with ABL and if women demonstrated age-related anal sphincter thinning. MethodsConsecutive patients with ABL presenting to our pelvic floor clinic from 2012 to 2017 were included. Clinical data were obtained from medical records. External anal sphincter (EAS), imaged by endoanal ultrasound at proximal, mid and distal locations, and IAS thickness were measured at 12, 3, 6, and 9 o'clock; puborectalis muscle (PRM) was measured at 4, 6, and 8 o'clock; and averaged. Anorectal manometry was conducted when clinically indicated. Data were compared using Mann-Whitney tests and linear regression. Results are reported as mean +/- SD or median (IQR). ResultsWomen (n = 136) were younger than men (n = 26) (61 +/- 13 vs. 67 +/- 13 years, p = 0.02). More women than men had pelvic surgery and less had colorectal surgery, spinal disorders, or a history of smoking (p < 0.05). Eighty-two percentage of women had an anal sphincter defect versus 31% of men (p < 0.01). All anal sphincter complex components were thinner in women than men with lower squeeze and resting pressures (p < 0.03), even in nulliparous women. Mean resting pressure was lower in older 6.1 (4.6-7.8) versus younger women 8.3 (5.0-12.9) mmHg, p = 0.04. ConclusionsWomen, even nulliparous, with ABL demonstrate thinner and weaker anal sphincters than men, Aging correlated with an increase in anal sphincter thickness, suggesting that age-related changes in the intrinsic components of the anal sphincter complex associated with ABL are complex and are not always well demonstrated on endoanal ultrasound.
引用
收藏
页码:751 / 760
页数:10
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