Normal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging

PURPOSE: To describe the various patterns of normal sphincter anatomy as seen at endoanal magnetic resonance (MR) imaging and to assess sex- and age-related variations in the dimensions of the anal sphincter to refine the diagnosis of sphincter disorders. MATERIALS AND METHODS: Endoanal MR imaging (1.5 T) was performed in 100 healthy volunteers (50 women, 50 men) evenly distributed between ages 20 and 85 years. The essential anatomic structures were evaluated, and various patterns in men and women were recorded. The thickness of the anal sphincter muscles and the length of the anal canal were measured, and age- and sex-related correlations were studied. RESULTS: Sex-related differences included a significantly shorter external sphincter in women than in men both laterally (mean, 27.1 mm +/- 5.4 vs 28.6 mm +/- 4.3; P < .05) and anteriorly (mean, 14.0 mm +/- 3.0 vs 27.0 mm +/- 53.0; P < .051). The superficial transverse perineal muscle is located more superiorly in women than in men. The central perineal tendon in men is a central muscular insertion point; in women, it represents an area where muscle fibers imbricate. Age-related variations included a significant decrease in the thickness of the external sphincter in men (P < .07). Significant decrease in the thickness of the longitudinal muscle-and increase in the thickness of the internal sphincter were noted in both sexes (P < .7). CONCLUSION: High-spatial-resolution endoanal MR. imaging provides excellent visualization of pelvic floor structures, Severe atrophy as it occurs in incontinent patients should be differentiated from physiologic, age-related thinning of the external sphincter and longitudinal muscle.