BACKGROUND: Demonstrate precisely the anatomic configuration of the anal canal and the length and thickness of the anal sphincters using three-dimensional (3-D) anorectal ultra-sonography in both genders. METHODS: Twelve normal volunteer males and 14 females, with a mean age of 52.4 and 50.3 years, respectively, were prospectively enrolled in this study. All individuals from both groups were submitted to anorectal ultra-sonography. The anal canal was analyzed, measuring the length and thickness of the external anal sphincter (EAE), internal anal sphincter (IAS), puborectalis muscle (PR) and the gap (distance from the anterior EAS to the anorectal junction) in the midline longitudinal (ML) and transverse (MT) planes, and the results were compared between quadrants and genders. RESULTS: The distribution of sphincter muscles is asymmetric in both genders. The anterior upper anal canal is an extension of the rectal wall with all layers clearly identified. The anterior IAS is formed in the distal upper anal canal and is significantly shorter in female than in male in all quadrants. The anterior IAS length is shorter than the posterior and lateral in both genders. The anterior EAS length is significantly shorter (2.2 cm) and the gap is longer (1.2 cm) in female than in male (3.4 cm) (0.7 cm) (p < 0.05), respectively. The posterior and lateral EAS-PR is significant longer in males (3.6 cm) (3.9 cm) than in females (3.2 cm) (3.5 cm) (p < 0.05), respectively. The lateral EAS-PR is significant longer than the posterior part in both genders. The anterior IAS is significantly thicker in males (0.19 cm) than in females (0.12 cm) (p = 0.04). CONCLUSION: 3-D anal endosonography enabled measurement of the different anatomical structures of the anal canal and demonstrated its asymmetrical configuration. The shorter anterior EAS and IAS associated with a longer gap could justify the higher incidence of pelvic floor dysfunction in females, especially fecal incontinence and anorectocele with rectal intussusception.
BACKGROUND: Demonstrate precisely the anatomic configuration of the anal canal and the length and thickness of the anal sphincters using three-dimensional (3-D) anorectal ultra-sonography in both genders. METHODS: Twelve normal volunteer males and 14 females, with a mean age of 52.4 and 50.3 years, respectively, were prospectively enrolled in this study. All individuals from both groups were submitted to anorectal ultra-sonography. The anal canal was analyzed, measuring the length and thickness of the external anal sphincter (EAE), internal anal sphincter (IAS), puborectalis muscle (PR) and the gap (distance from the anterior EAS to the anorectal junction) in the midline longitudinal (ML) and transverse (MT) planes, and the results were compared between quadrants and genders. RESULTS: The distribution of sphincter muscles is asymmetric in both genders. The anterior upper anal canal is an extension of the rectal wall with all layers clearly identified. The anterior IAS is formed in the distal upper anal canal and is significantly shorter in female than in male in all quadrants. The anterior IAS length is shorter than the posterior and lateral in both genders. The anterior EAS length is significantly shorter (2.2 cm) and the gap is longer (1.2 cm) in female than in male (3.4 cm) (0.7 cm) (p < 0.05), respectively. The posterior and lateral EAS-PR is significant longer in males (3.6 cm) (3.9 cm) than in females (3.2 cm) (3.5 cm) (p < 0.05), respectively. The lateral EAS-PR is significant longer than the posterior part in both genders. The anterior IAS is significantly thicker in males (0.19 cm) than in females (0.12 cm) (p = 0.04). CONCLUSION: 3-D anal endosonography enabled measurement of the different anatomical structures of the anal canal and demonstrated its asymmetrical configuration. The shorter anterior EAS and IAS associated with a longer gap could justify the higher incidence of pelvic floor dysfunction in females, especially fecal incontinence and anorectocele with rectal intussusception.
Authors: F S P Regadas; S M Murad-Regadas; S D Wexner; L V Rodrigues; M H L P Souza; F R Silva; D M R Lima; F S P Regadas Filho Journal: Colorectal Dis Date: 2007-01 Impact factor: 3.788
Authors: Sthela Maria Murad Regadas; Francisco Sergio P Regadas; Lusmar Veras Rodrigues; Flavio Roberto Silva; Doryane Maria dos Reis Lima; Francisco Sergio Pinheiro Regadas-Filho Journal: Arq Gastroenterol Date: 2006-01-19
Authors: Sthela M Murad-Regadas; F Sérgio P Regadas; Lusmar V Rodrigues; Flavio R Silva; Fabio A Soares; Rodrigo D Escalante Journal: Surg Endosc Date: 2007-08-20 Impact factor: 4.584
Authors: M Oberwalder; K Thaler; M K Baig; A Dinnewitzer; J Efron; E G Weiss; A M Vernava; J J Nogueras; S D Wexner Journal: Surg Endosc Date: 2004-03-19 Impact factor: 4.584
Authors: F S P Regadas; R G Lima Barreto; S M Murad-Regadas; L Veras Rodrigues; L M Pereira Oliveira Journal: Tech Coloproctol Date: 2012-03-02 Impact factor: 3.781
Authors: F Luft; L Fynne; H Gregersen; F Lundager; S Buntzen; L Lundby; S Laurberg; K Krogh Journal: Tech Coloproctol Date: 2012-08-31 Impact factor: 3.781
Authors: Kate V Meriwether; Mark E Lockhart; Isuzu Meyer; Holly E Richter Journal: Female Pelvic Med Reconstr Surg Date: 2019 Jan/Feb Impact factor: 2.091
Authors: Sthela M Murad-Regadas; Graziela Olivia da S Fernandes; Francisco Sergio Pinheiro Regadas; Lusmar Veras Rodrigues; Francisco Sergio Pinheiro Regadas Filho; Iris Daiana Dealcanfreitas; Adjra da Silva Vilarinho; Mariana Murad da Cruz Journal: Int J Colorectal Dis Date: 2016-12-29 Impact factor: 2.571
Authors: Sthela M Murad-Regadas; Francisco Sergio P Regadas; Lusmar V Rodrigues; Rosilma G L Barreto; Francisco Coracy C Monteiro; Beethoven B Landim; Erico C Holanda Journal: Surg Endosc Date: 2008-09-24 Impact factor: 4.584
Authors: Sthela M Murad-Regadas; Francisco Sérgio P Regadas; Lusmar V Rodrigues; Leticia Oliveira; Rosilma G L Barreto; Marcellus H L P de Souza; Flavio Roberto S Silva Journal: Int J Colorectal Dis Date: 2009-06-03 Impact factor: 2.571
Authors: Sthela M Murad-Regadas; F Sérgio P Regadas; Lusmar V Rodrigues; Flavio R Silva; Fabio A Soares; Rodrigo D Escalante Journal: Surg Endosc Date: 2007-08-20 Impact factor: 4.584