One possible cause of fecal incontinence (the uncontrolled loss of liquid or solid stool) in young, healthy women is vaginal delivery, especially when the woman had a tear in the anal sphincter (muscles surrounding the anal opening) at the time of the vaginal delivery. Ultrasound can be used to see if there is a "gap" in either the external anal sphincter (the outer muscle) or the internal anal sphincter (the inner muscle). The purpose of this study was to determine if ultrasound can be used to identify more gaps or damage 6-12 months after vaginal delivery in women that had a sphincter tear at the time of delivery of their first baby than in women who did not have a sphincter tear. We also wished to see if these ultrasound findings were associated with fecal incontinence and its severity.

The study found that:

• There were more gaps seen in women that had a sphincter tear at the time of vaginal delivery compared to those women without a tear at delivery or women who had a cesarean delivery without labor.
• Increased severity of fecal incontinence was seen in women with gaps in the internal anal sphincter. Greatest severity was seen in women with gaps in both the internal and external sphincters.

The use of ultrasound in the evaluation of women with fecal incontinence may help to determine whether a gap is present in the anal sphincter that may be treated by surgical repair especially when the woman had a sphincter tear at the time of vaginal delivery.

STUDY RESULTS:

Richter HE, Fielding JR, Bradley CS, Handa VL, Fine P, Fitzgerald MP, Visco A, Wald A, Hakim C, Wei JT, Weber AM, Pelvic Floor Disorders Network. Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstetrics and gynecology. 2006 Dec; 108(6): 1394-401.

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Bradley CS, Richter HE, Gutman RE, Brown MB, Whitehead WE, Fine PM, Hakim C, Harford F, Weber AM, Pelvic Floor Disorders Network. Risk factors for sonographic internal anal sphincter gaps 6-12 months after delivery complicated by anal sphincter tear. American journal of obstetrics and gynecology. 2007 Sep; 197(3): 310.e1-5.

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Handa VL, Lockhart ME, Fielding JR, Bradley CS, Brubaker L, Cundiff GW, Ye W, Richter HE, Pelvic Floor Disorders Network. Racial differences in pelvic anatomy by magnetic resonance imaging. Obstetrics and gynecology. 2008 Apr; 111(4): 914-20.

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Handa VL, Lockhart ME, Kenton KS, Bradley CS, Fielding JR, Cundiff GW, Salomon CG, Hakim C, Ye W, Richter HE. Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth. International urogynecology journal and pelvic floor dysfunction. 2009 Feb; 20(2): 133-9.

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Hoyte L, Brubaker L, Fielding JR, Lockhart ME, Heilbrun ME, Salomon CG, Ye W, Brown MB, Pelvic Floor Disorders Network. Measurements from image-based three dimensional pelvic floor reconstruction: a study of inter- and intraobserver reliability. Journal of magnetic resonance imaging : JMRI. 2009 Aug; 30(2): 344-50.

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Heilbrun ME, Nygaard IE, Lockhart ME, Richter HE, Brown MB, Kenton KS, Rahn DD, Thomas JV, Weidner AC, Nager CW, Delancey JO. Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. American journal of obstetrics and gynecology. 2010 May; 202(5): 488.e1-6.

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Hoyte L, Ye W, Brubaker L, Fielding JR, Lockhart ME, Heilbrun ME, Brown MB, Warfield SK, Pelvic Floor Disorders Network. Segmentations of MRI images of the female pelvic floor: a study of inter- and intra-reader reliability. Journal of magnetic resonance imaging : JMRI. 2011 Mar; 33(3): 684-91.

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Lockhart ME, Fielding JR, Richter HE, Brubaker L, Salomon CG, Ye W, Hakim CM, Wai CY, Stolpen AH, Weber AM. Reproducibility of dynamic MR imaging pelvic measurements: a multi-institutional study. Radiology. 2008 Nov; 249(2): 534-40.

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