Significance of pelvic floor muscles in anal incontinence

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Significance of pelvic floor muscles in anal incontinence Xose Fernández–Fraga, Fernando Azpiroz, Juan–R. Malagelada Gastroenterology Volume 123, Issue 5, Pages 1441-1450 (November 2002) DOI: 10.1053/gast.2002.36586 Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 1 Perineal dynamometer. The contraction of the levator ani was measured as the traction exerted on an intrarectal balloon catheter, connected to an isometric dynamometer, fixed by an articulated support to the pelvic bones. Scanned picture of the articulated support shown. Gastroenterology 2002 123, 1441-1450DOI: (10.1053/gast.2002.36586) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 2 Example of levator ani contraction. The peak force of 3 consecutive contractions was averaged for calculations. Figure corresponds to incontinent patient. Gastroenterology 2002 123, 1441-1450DOI: (10.1053/gast.2002.36586) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 3 Clinicophysiologic correlations. Levator ani contraction was the independent variable with strongest relation to the severity of incontinence. Figure shows regression line (—), prediction, and 95% confidence intervals. Gastroenterology 2002 123, 1441-1450DOI: (10.1053/gast.2002.36586) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 4 Response to treatment. Both the incontinence score and the force of levator ani markedly improved after biofeedback treatment. *P < 0.05 vs. pretreatment. Gastroenterology 2002 123, 1441-1450DOI: (10.1053/gast.2002.36586) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 5 Example of levator ani and external sphincter sustained contraction. The levator ani exhibited significantly less fatigability than the external anal sphincter. Figure corresponds to constipated patient. Gastroenterology 2002 123, 1441-1450DOI: (10.1053/gast.2002.36586) Copyright © 2002 American Gastroenterological Association Terms and Conditions