Sa416 FATIGABILITY OF THE PUBORECTALIS MUSCLE BY REPETITIVE ANAL CONTRACTIONS AGAINST THE CONTINENCE MUSCLES RESISTANCE EXERCISER DEVICE

AbstractThere is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed “digital manometry”) and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were −7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, −37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and −20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.

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Functional Correlates of Anal Canal Anatomy: Puborectalis Muscle and Anal Canal Pressure

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2006.00596.x ◽

2006 ◽

Vol 101 (5) ◽

pp. 1092-1097 ◽

Cited By ~ 61

Author(s):

Jianmin Liu ◽

Noelani Guaderrama ◽

Charles W. Nager ◽

Dolores H. Pretorius ◽

Sonali Master ◽

...

Keyword(s):

Anal Canal ◽

Puborectalis Muscle

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Pre-Clinical Applications of High-Definition Manometry System to Investigate Pelvic Floor Muscle Contribution to Continence Mechanisms in a Rabbit Model

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00295.2021 ◽

2021 ◽

Author(s):

Samuel Sorkhi ◽

Youngjin Seo ◽

Valmik Bhargava ◽

Mahadevan Raj Rajasekaran

Keyword(s):

Electrical Stimulation ◽

Anal Canal ◽

Dynamic Pressure ◽

Rabbit Model ◽

Puborectalis Muscle ◽

High Definition ◽

System Pressure ◽

Vaginal Canal ◽

The Impact ◽

Stimulation Of

External anal sphincter (EAS), external urethral sphincters and puborectalis muscle (PRM) have important roles in the genesis of anal and urethral closure pressures. In the present study, we defined the contribution of these muscles alone and in combination to the sphincter closure function using a rabbit model and a high-definition manometry (HDM) system. A total of 12 female rabbits were anesthetized and prepared to measure anal, urethral, and vaginal canal pressures using a HDM system. Pressure was recorded at rest, and during electrical stimulation of the EAS and PRM. A few rabbits (n=6) were subjected to EAS injury and the impact of EAS injury on the closure pressure profile was also evaluated. Anal, urethral, and vaginal canal pressures recorded at rest and during electrical stimulation of EAS and PRM demonstrated distinct pressure profiles. EAS stimulation induced anal canal pressure increase whereas PRM stimulation increased the pressures in all the three orifices. Electrical stimulation of EAS after injury resulted in about 19% decrease in anal canal pressure. Simultaneous electrical stimulation of EAS and PRM resulted in an insignificant increase of individual anal canal pressures when compared to pressures recorded after EAS or PRM stimulations alone. Our data confirm that HDM is a viable system to measure dynamic pressure changes within the three orifices and to define the role of each muscle in the development of closure pressures within these orifices in preclinical studies.

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Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032010000400009 ◽

2010 ◽

Vol 47 (4) ◽

pp. 368-372 ◽

Cited By ~ 4

Author(s):

Sthela Maria Murad-Regadas ◽

Francisco Sérgio P Regadas ◽

Rosilma Gorete Lima Barreto ◽

Lusmar Veras Rodrigues ◽

Graziela Olivia da Silva Fernandes ◽

...

Keyword(s):

Prospective Study ◽

Anal Canal ◽

Anal Manometry ◽

Obstructed Defecation ◽

Puborectalis Muscle ◽

Two Dimensional ◽

Kappa Index ◽

Index Of Agreement ◽

Anorectal Ultrasonography ◽

A Prospective Study

CONTEXT: Anismus is a prevalent functional cause of outlet delay. It is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles. OBJECTIVE: To evaluate the ability of two dimensional anal ultrasonography to identify anismus patients with paradoxical contraction or normal relaxation, comparing findings with manometric measurements. METHODS: Forty-nine women presenting with outlet delay and a mean validated Wexner constipation score of 13.5 were included in a prospective study. Following screening with anal manometry, the patients were assigned to one of two groups: G-I -with normal relaxation and G-II -patients with anismus. Dynamic anorectal ultrasonography was used to quantifier the movement of the puborectalis muscle and to measure changes in the angle between two converging lines drawn from the 3 o'clock and the 9 o'clock positions of the endoprobe circumference to the internal border of the puborectalis muscle. The angle decreases during straining in patients with normal relaxation, but increases in patients with anismus. The agreement between the two techniques was verified with the Kappa index. RESULTS: In manometry, during straining the anal canal pressure decreased by 41.3% in G-I and increased by 168.6% in G-II, indicating a diagnosis of anismus for the second group. In US, during straining, the angle produced by the movement of the puborectalis muscle decreased from 63 ± 1.31 to 58 ± 1.509 degrees (P = 0.0135) in 23 of the 30 patients in G-I, indicating normal relaxation, and increased from 66 ± 0.972 to 72 ± 0.897 degrees (P = 0.0001) in 16 of the 19 patients in G-II, indicating anismus. The index of agreement between manometry and two dimensional anal ultrasonography was moderate: 77% (23/30) for G-I and 84% (16/19) for G-II. CONCLUSION: Two-dimensional dynamic anal ultrasonography showed similar results previously suggested by anal manometry at identifying patients with normal relaxation or paradoxical contraction.

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MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0065-0 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Heba Azzam ◽

Manal Halim ◽

Hany El-Assaly ◽

Aya Heiba

Keyword(s):

Pelvic Floor ◽

Treatment Plan ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Control Group ◽

Puborectalis Muscle ◽

Levator Ani Muscle ◽

Vaginal Deliveries ◽

Significant Difference ◽

Muscle Changes

Abstract Background Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

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OP16.03: Use of 3D ultrasound to assess puborectalis muscle measurements

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.3330 ◽

2006 ◽

Vol 28 (4) ◽

pp. 495-496

Author(s):

M. M. Weinstein ◽

S. A. Jung ◽

D. H. Pretorius ◽

C. W. Nager ◽

B. S. Padda ◽

...

Keyword(s):

3D Ultrasound ◽

Puborectalis Muscle

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