Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women

Milena M. Weinstein, Dolores H. Pretorius, Sung Ae Jung, Jennifer J. Wan, Charles W. Nager, Ravinder K. Mittal

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Introduction and hypothesis: We aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women. Methods: 3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups. Results: Forty-four of 45 subjects had adequate PRM images. The injured PRM (N=14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N=30; p=0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon. Conclusions: In asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.

Original languageEnglish
Pages (from-to)1143-1150
Number of pages8
JournalInternational Urogynecology Journal
Issue number9
StatePublished - Sep 2011

Bibliographical note

Funding Information:
Financially supported by NIH RO1 grant DK60733


  • Anal manometry
  • Anal sphincter complex
  • Three-dimensional ultrasound
  • Vaginal manometry


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