P Tirumanisetty1, D Prichard1, J G Fletcher2, S Chakraborty1, A R Zinsmeister3, A E Bharucha1. 1. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA. 2. Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA. 3. Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA.
Abstract
BACKGROUND: Endoanal MRI and MR defecography are used to identify anal sphincter injury and disordered defecation. However, few studies have evaluated findings in asymptomatic healthy people. The effects of BMI and parity on rectoanal motion and evacuation are unknown. METHODS: In 113 asymptomatic females (age 50 ± 17 years, Mean ± SD) without risk factors for anorectal trauma, anal sphincter appearance, anorectal motion, and pelvic organ prolapse were evaluated with MRI. The relationship between age, BMI, and parity and structural findings were evaluated with parametric and non-parametric tests. RESULTS: The anal sphincters and puborectalis appeared normal in over 90% of women. During dynamic MRI, the anorectal angle was 100 ± 1º (Mean ± SEM) at rest, 70 ± 2° at squeeze, and 120 ± 2° during defecation. The change in anorectal angle during squeeze (r = -.25, P < .005), but not during evacuation (r = .13, P = .25) was associated with age. In the multivariable models, BMI (P < .01) and parity (P < .01) were, respectively, independently associated with the intersubject variation in the anorectal angle at rest and the angle change during squeeze. Ten percent or fewer women had had descent of the bladder base or uterus 4 cm or more below the pubococcygeal line or a rectocele measuring 4 cm or larger. Only 5% had a patulous anal canal. CONCLUSIONS: In addition to age, BMI and parity also affect anorectal motion in asymptomatic women. These findings provide age-adjusted normal values for rectoanal anatomy and pelvic floor motion.
BACKGROUND: Endoanal MRI and MR defecography are used to identify anal sphincter injury and disordered defecation. However, few studies have evaluated findings in asymptomatic healthy people. The effects of BMI and parity on rectoanal motion and evacuation are unknown. METHODS: In 113 asymptomatic females (age 50 ± 17 years, Mean ± SD) without risk factors for anorectal trauma, anal sphincter appearance, anorectal motion, and pelvic organ prolapse were evaluated with MRI. The relationship between age, BMI, and parity and structural findings were evaluated with parametric and non-parametric tests. RESULTS: The anal sphincters and puborectalis appeared normal in over 90% of women. During dynamic MRI, the anorectal angle was 100 ± 1º (Mean ± SEM) at rest, 70 ± 2° at squeeze, and 120 ± 2° during defecation. The change in anorectal angle during squeeze (r = -.25, P < .005), but not during evacuation (r = .13, P = .25) was associated with age. In the multivariable models, BMI (P < .01) and parity (P < .01) were, respectively, independently associated with the intersubject variation in the anorectal angle at rest and the angle change during squeeze. Ten percent or fewer women had had descent of the bladder base or uterus 4 cm or more below the pubococcygeal line or a rectocele measuring 4 cm or larger. Only 5% had a patulous anal canal. CONCLUSIONS: In addition to age, BMI and parity also affect anorectal motion in asymptomatic women. These findings provide age-adjusted normal values for rectoanal anatomy and pelvic floor motion.
Authors: Andrea Macaluso; Myra A Nimmo; John E Foster; Muriel Cockburn; Nigel C McMillan; Giuseppe De Vito Journal: Muscle Nerve Date: 2002-06 Impact factor: 3.217
Authors: Adil E Bharucha; Alan R Zinsmeister; G Richard Locke; Barbara M Seide; Kimberly McKeon; Cathy D Schleck; L Joseph Melton Journal: Gastroenterology Date: 2005-07 Impact factor: 22.682
Authors: J C Healy; S Halligan; R H Reznek; S Watson; C I Bartram; M A Kamm; R K Phillips; P Armstrong Journal: Br J Surg Date: 1997-11 Impact factor: 6.939
Authors: Marianna Alperin; Mark Cook; Lori J Tuttle; Mary C Esparza; Richard L Lieber Journal: Am J Obstet Gynecol Date: 2016-03-05 Impact factor: 8.661
Authors: Adil E Bharucha; Jasper Daube; William Litchy; Julia Traue; Jessica Edge; Paul Enck; Alan R Zinsmeister Journal: Am J Physiol Gastrointest Liver Physiol Date: 2012-05-10 Impact factor: 4.052
Authors: Subhankar Chakraborty; Kelly Feuerhak; Anjani Muthyala; William S Harmsen; Kent R Bailey; Adil E Bharucha Journal: Clin Gastroenterol Hepatol Date: 2018-08-18 Impact factor: 11.382
Authors: Susrutha Puthanmadhom Narayanan; Mayank Sharma; Joel G Fletcher; Ronald A Karwoski; David R Holmes; Adil E Bharucha Journal: Neurogastroenterol Motil Date: 2019-04-26 Impact factor: 3.598
Authors: Nicholas R Oblizajek; Sangeetha Gandhi; Mayank Sharma; Subhankar Chakraborty; Anjani Muthyala; David Prichard; Kelly Feuerhak; Adil E Bharucha Journal: Neurogastroenterol Motil Date: 2019-04-08 Impact factor: 3.598
Authors: Paul T Heitmann; Paul F Vollebregt; Charles H Knowles; Peter J Lunniss; Phil G Dinning; S Mark Scott Journal: Nat Rev Gastroenterol Hepatol Date: 2021-08-09 Impact factor: 46.802
Authors: Brototo Deb; Mayank Sharma; Joel G Fletcher; Sushmitha Grama Srinivasan; Alexandra Chronopoulou; Jun Chen; Kent R Bailey; Kelly J Feuerhak; Adil E Bharucha Journal: Gastroenterology Date: 2021-12-22 Impact factor: 22.682