The use of endoluminal ultrasound in the assessment of patients with faecal incontinence.

To determine the clinical value of endoanal ultrasonography in the assessment of patients with faecal incontinence, we have assessed 98 patients with neurogenic incontinence (median age 58 years, 85 women). Twenty-one patients with a history of previous anal surgery (13 men), 12 nulliparous women, and 73 women with an obstetric history (including eight with previous anal surgery) were assessed. All of the patients who had undergone surgery and 43 patients with a previous obstetric history had abnormalities identified by ultrasound. Endoanal ultrasound identified two internal sphincter injuries in patients who were suspected of having an external sphincter defect alone. In addition, in 18 patients who had an obstetric history but no documented obstetric trauma, defects were identified in the external sphincter by ultrasonography. The technique appears most useful in those patients with an obstetric history and/or a previous history of anal surgery. Symptoms of incontinence were most severe in those who had internal sphincter division.