RESUMO
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.
Assuntos
Canal Anal/anatomia & histologia , Canal Anal/diagnóstico por imagem , Postura , Adulto , Endossonografia , Incontinência Fecal/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estatísticas não ParamétricasRESUMO
BACKGROUND: Faecal incontinence affects a heterogeneous population and aetiology can be multifactorial. In a subset of patients the aetiology remains idiopathic despite standard investigations. Anal cushions are important in normal continence, but have rarely been studied. The aim of this study was to measure the size of the anal cushions and to evaluate their role in patients with idiopathic faecal incontinence. METHODS: Women in whom idiopathic faecal incontinence was diagnosed after standard anorectal investigations underwent transvaginal ultrasonography. The area of the anal cushions was measured and a cushion : canal (C : C) ratio derived, which was compared with that in a control group of women without faecal incontinence. RESULTS: Some 21 patients with incontinence (median age 60 years) and 102 asymptomatic controls (median age 41 years) underwent scanning. The median (interquartile range) C : C ratio in the symptomatic group was significantly lower than that for controls (0.57 (0.54-0.66) versus 0.68 (0.61-0.73) respectively; P = 0.001). C : C ratio was not influenced by age (r = 0.023, P = 0.821). CONCLUSION: The C : C ratio was reduced in patients with idiopathic faecal incontinence.
Assuntos
Canal Anal/patologia , Tecido Conjuntivo/fisiologia , Incontinência Fecal/etiologia , Canal Anal/diagnóstico por imagem , Canal Anal/fisiopatologia , Estudos de Casos e Controles , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Manometria , Pessoa de Meia-Idade , Qualidade de Vida , Recidiva , Índice de Gravidade de Doença , UltrassonografiaRESUMO
We describe a rare cause of irregular vaginal bleeding due to a haemangioma of the uterine cervix. Clinical, ultrasound and MRI appearances are shown and options for management discussed.
Assuntos
Hemangioma/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Colposcopia , Feminino , Humanos , Hemorragia Uterina/etiologiaRESUMO
Lateral X-ray pelvimetry was performed on 63 women in the sitting and squatting positions on the 5th or 6th post-natal day to assess whether squatting has any effect on pelvic dimensions. Four assessors measured the inlet and outlet pelvic dimensions from 25 cases with good radiographic views in order to minimise observer bias. There was no statistically significant change in pelvic dimensions with squatting. Some possible explanations are discussed.