The Levator Plate Architecture Is Altered in Women with Fecal Incontinence

Abstract

Objectives: This study aimed to assess the architecture of the levator plate and anal complex in women with fecal incontinence using 3-dimensional endoanal ultrasound (EAUS). Methods: A retrospective cohort study reviewed EAUS examinations performed on women with fecal incontinence. The anal complex and levator plate architecture were examined and compared to a control group of women without fecal incontinence. The anal canal was divided into 6 different areas, and the visibility of specific structures was recorded. Measurements of the external anal sphincter (EAS) length, levator plate length, and the distance between the EAS and the levator plate were taken. Results: The study included 31 patients with fecal incontinence and 30 nulliparous controls. Significant differences were observed in the anal complex anatomy between the 2 groups. The fecal incontinence group had a higher prevalence of abnormal levator plate anatomy (84%) than the control group (3%). The EAS size was significantly smaller in the fecal incontinent group (16 versus 18 mm, P =.04), and there was a shorter distance between the EAS and the levator plate (22 versus 28 mm, P =.001). Conclusions: Women with fecal incontinence exhibited significant changes in the anatomy of the anal canal, particularly in caudad structures of the anal sphincter complex. Additionally, a shorter distance between the levator plate and the EAS was observed in fecal incontinent patients. Sonographic assessment adds much to the evaluation of defecatory disorders.