Abstract

Summary

To assess clinical forms, risk factors, and structural-functional features of combined anal and urinary insufficiency in women using a comprehensive pelvic floor evaluation.
 

Materials and Methods

A comparative cohort study included 104 women with clinical manifestations of anal sphincter insufficiency. Group 1 comprised 56 patients with isolated anal sphincter insufficiency; group 2 included 48 patients with combined insufficiency, defined as concomitant anal and urinary incontinence. The diagnostic algorithm included clinical assessment, Wexner, ICIQ-SF and FIQL scales, anorectal manometry, electromyography, pudendal nerve terminal motor latency assessment, urodynamic testing, 3D pelvic floor ultrasound and pelvic MRI. Quantitative variables are presented as median and interquartile range - Me [Q1-Q3].
 

Results

Patients with combined insufficiency had more severe continence impairment than those with isolated anal sphincter insufficiency: Wexner score 14 [13-15] vs 9 [8-10], FIQL 1.9 [1.7-2.1] vs 3.2 [2.9-3.3], resting anal pressure 30.4 [25.1-35.2] vs 43.2 [39.2-46.7] mmHg, and pudendal nerve latency 3.1 [3.0-3.3] vs 2.4 [2.2-2.7] ms (all p<0.001). Independent predictors were combined internal and external anal sphincter defect, third- and fourth-degree perineal tears, levator deficiency and connective tissue dysplasia.
 

Conclusion

Combined insufficiency in women represents a complex pelvic floor disorder involving sphincteric, levator, fascial and neurogenic components. Risk stratification should combine obstetric history, imaging findings, neurophysiological testing and systemic connective tissue factors.
 

Keywords

anal sphincter insufficiency; urinary incontinence; pelvic floor; levator deficiency; pudendal neuropathy

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