A Novel Procedure to Assess Anismus Using Three-dimensional Dynamic Anal Ultrasonography

Objective: This study aimed to determine the value of three-dimensional (3D) dynamic endosonography in the assessment of anismus.

Method: Sixty-one women submitted to anorectal manometry were enrolled including 40 healthy women and 21 patients with anismus diagnosed by manometry. Patients were submitted to 3D endosonography. Images were acquired at rest and during straining and analysed in axial and midline longitudinal planes. Sphincter integrity was quantified. The angle between the internal edge of the puborectalis with a vertical line according to the anal canal axis was calculated at rest and during straining.

Results: The angle increased in 39 of the 40 normal individuals and decreased in all patients with anismus during straining compared with the angle at rest (88.36 degrees ) and straining (98.65 degrees ) in normal individuals. In the anismus group, the angle decreased at rest (90.91 degrees ) and straining (84.89 degrees ). The difference between angle sizes in normal and anismus patients during straining was statistically significant (P < 0.5).

Conclusion: Three-dimensional endosonography is a useful method to assess patients with anismus confirming the anorectal manometric results.