Measurement of anal cushions in continent women

• Published in: Colorectal disease 2011-09, Vol.13 (9), p.1040-1043
• Main Authors: Thekkinkattil, D. K., Dunham, R. J., O'Herlihy, S., Finan, P. J., Sagar, P. M., Burke, D. A.
• Format: Article
• Language: English
• Subjects: Adult; Anal Canal - anatomy & histology; Anal Canal - diagnostic imaging; anal cushions; Anal incontinence; Endosonography; Fecal Incontinence - etiology; Female; Humans; Middle Aged; Observer Variation; Posture; Statistics, Nonparametric; ultrasound scan
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2010.02316.x

Aim  Anal cushions are connective tissue complexes thought to be involved in anal continence. This study aimed to assess them in continent subjects. Method  Continent women undergoing a transvaginal ultrasound scan for gynaecological reasons were included. The anal cushions were visualized at the mid‐canal level. The cross‐sectional area within the internal anal sphincter (Area 1) and the area enclosed within the anal cushions (Area 2) were measured and a Cushion:Canal (C:C) ratio was derived for each patient. The measurements were repeated in the semi‐erect position. Results  One hundred and two patients with a median age of 41 (IQR 32–49) years were included. The median C:C ratio was 0.68 (IQR 0.61–0.73). Inter‐observer error was 0.98 and intra‐observer error was 0.99. There was no significant correlation between age and C:C ratio. The C:C ratio was significantly higher in parous than in nulliparous women (P = 0.04). A history of obstetric trauma or minimal haemorrhoidal symptoms did not influence C:C ratio. There was a significant increase in C:C ratio in the erect position. (P = 0.04). Conclusion  There was a wide range of variability in the measurement of anal cushions in normal continent women. These were not influenced by age.