Two-dimensional Introital Sonography in Patterns of Anorectal Prolapse in Women

  • Vittorio Piloni
  • Liana Spazzafumo


The anal cross-sectional area on 2D introital ultrasonography (IUS) represents a new sensitive index capable of providing both superior anatomic details and clear depiction of anorectal prolapse in women. The parameter is calculated at rest and on straining by outlining the inner and the outer margin of the hypoechoic internal anal sphincter (IAS) and measuring the included area at the level of the middle anal canal in the axial plane. Average values of the inner area (1.08 ± 0.25 cm2 vs 3.02 ± 0.73 cm2), as well as the inner-to-outer ratio (49.6 ± 8.2 % vs 81.3 ± 2.9 %) and percentage increase on straining (Δ-0.007 vs +0.42) have been found by us to differ significantly (p < 0.01) in control groups (n = 10) and patients with rectal prolapse (n = 20). Further differentiation is made possible at sonography between those patients with rectal prolapse and obstructed defecation as their main presenting symptom from those with staining episodes and/or fecal incontinence by noting whether or not the integrity of the anal sphincter is preserved. Thanks to rapid advances in technology and recent refinements in interpretation, IUS can be considered, especially in young female patients, the best imaging modality to start with in assessing rectal prolapse in a safe and noninvasive manner.


Pelvic Floor Fecal Incontinence Anal Sphincter Anal Canal Rectal Prolapse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ekberg O, Mahieu PHG, Bartram CI et al (1990) Defecography: dynamic radiological imaging in proctology. Gastroenterol Int 3:63–69Google Scholar
  2. 2.
    Kelvin FM, Maglinte DDT, Benson JT (1994) Evacuation proctography (defecography): an aid to the investigation of pelvic floor disorders. Obstet Gynecol 83:307–314PubMedGoogle Scholar
  3. 3.
    Hock D, Lombard R, Jehaes C et al (1993) Colpo — cystodefecography. Dis Colon Rectum 36:1015–1021PubMedCrossRefGoogle Scholar
  4. 4.
    Kelvin FM, Maglinte DDT, Benson JT et al (1994) Dynamic cystoproctography: a technique for assessing disorders of the pelvic floor in women. AJR Am J Roentgenol 163:368–370PubMedGoogle Scholar
  5. 5.
    Piloni V, Spazzafumo L (2007) Sonography of the female pelvic floor: clinical indications and techniques. Pelviperineology 26:59–65Google Scholar
  6. 6.
    Rubens DJ, Strang JG, Bogineni-Misra S et al (1988) Transperineal sonography of the rectum: anatomy and pathology revealed by sonography compared with CT and MR imaging. AJR Am J Roentgenol 170:637–642Google Scholar
  7. 7.
    Chang TS, Bohm-Velez M, Mendelson EB (1993) Nongynecological applications of transvaginal sonography AJR Am J Roentgenol 160:87–93PubMedGoogle Scholar
  8. 8.
    Sultan AH, Loder PB, Bartram CI et al (1994) Vaginal endosonography: new approach to image the undisturbed anal sphincter. Dis Colon Rectum 37:1296–1299PubMedCrossRefGoogle Scholar
  9. 9.
    Sandridge DA, Thorp JM (1995) Vaginal endosonography in the assessment of the anorectum. Obstet Gynecol 86:1007–1009PubMedCrossRefGoogle Scholar
  10. 10.
    Halligan S, Northover J, Bartram CI (1996) Vaginal endosonography to diagnose enterocele. Br J Radiol 69:996–999PubMedCrossRefGoogle Scholar
  11. 11.
    Alexander AA, Liu JB, Merton DA et al (1997) Fecal incontinence: transvaginal US evaluation of anatomic causes Radiology 199:529–532Google Scholar
  12. 12.
    Peschers UM, DeLancey JO, Schaer GN et al (1997) Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol 104(9):999–1003PubMedGoogle Scholar
  13. 13.
    Stewart LR, Wilson SR (1999) Transvaginal sonography of the anal sphincter: reliable or not? AJR Am J Roentgenol 173(1):179–185PubMedGoogle Scholar
  14. 14.
    Piloni V (2001) Dynamic imaging of pelvic floor with transperineal sonography. Tech Coloproctol 5:103–105PubMedCrossRefGoogle Scholar
  15. 15.
    Beer-Gabel M, Zbar AP (2002) Dynamic transperineal ultrasound in patients presenting with obstructed evacuation Tech Coloproctol 6:141CrossRefGoogle Scholar
  16. 16.
    Piloni V, Spazzafumo L (2005) Evacuation sonography. Tech Coloproctol 9:119–126PubMedCrossRefGoogle Scholar
  17. 17.
    Kelvin FM. Maglinte DDT, Hale DS et al (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88PubMedGoogle Scholar
  18. 18.
    Phillips SF, Edwards DAW (1965) Some aspect of anal continence and defecation. Gut 6:396–406PubMedCrossRefGoogle Scholar
  19. 19.
    Piloni VL, Bazzocchi A, Golfieri R (2007) Functional imaging in rectal prolapse. In: Altomare DF, Pucciani F (eds) Rectal prolapse. Springer-Verlag Italia, pp 21–32Google Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Vittorio Piloni
    • 1
  • Liana Spazzafumo
    • 2
  1. 1.Diagnostic Imaging CentrePrivate Clinic “Villa Silvia”Senigallia, AnconaItaly
  2. 2.Center of Statistics Department of Ageing Geriatric ResearchInstitute I.N.R.C.A.AnconaItaly

Personalised recommendations