Effect of Aging on Anorectal and Pelvic Floor Functions in Females |
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Authors: | Jean C Fox MD Joel G Fletcher MD Alan R Zinsmeister PhD Barb Seide Stephen J Riederer MD Adil E Bharucha MD |
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Institution: | (1) Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;(2) Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;(3) Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;(4) Clinical and Enteric Neuroscience Translational and Epidemiologic Research Program (C.E.N.T.E.R.), Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905, USA |
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Abstract: | Purpose In females, fecal incontinence often is attributed to birth trauma; however, symptoms sometimes begin decades after delivery,
suggesting that anorectal sensorimotor functions decline with aging.
Methods In 61 asymptomatic females (age, 44 ± 2 years, mean ± standard error of the mean) without risk factors for anorectal trauma,
anal pressures, rectal compliance, and sensation were assessed by manometry, staircase balloon distention, and a visual analog
scale during phasic distentions respectively. Anal sphincter appearance and pelvic floor motion also were assessed by static
and dynamic magnetic resonance imaging respectively in 38 of 61 females.
Results Aging was associated with lower anal resting (r = −0.44, P < 0.001) and squeeze pressures (r = −0.32, P = 0.01), reduced rectal compliance (i.e., r for pressure at half-maximum volume vs. age = 0.4, P = 0.001), and lower (P ≤ 0.002) visual analog scale scores during phasic distentions at 16 (r = −0.5) and 24 mmHg (r = −0.4). Magnetic resonance imaging revealed normal anal sphincters in 29 females and significant sphincter injury, not associated
with aging, in 9 females. The location of the anorectal junction at rest (r = 0.52, P < 0.001), squeeze (r = 0.62, P < 0.001), and Valsalva maneuver (r = 0.35, P = 0.03), but not anorectal motion (e.g., from resting to squeeze) was associated with age.
Conclusions In asymptomatic females, aging is associated with reduced anal resting and squeeze pressures, reduced rectal compliance, reduced
rectal sensation, and perineal laxity. Together, these changes may predispose to fecal incontinence in elderly females.
Supported in part by Grants R01 HD38666, R01 HD41129, and R01 EB00212 (SJR) and General Clinical Research Center grant M01
RR00585 from the National Institutes of Health, U.S. Public Health Service.
Presented at the meeting of the American Gastroenterological Association, Atlanta, Georgia, May 20 to 23, 2001.
An erratum to this article is available at . |
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Keywords: | Sensorimotor Fecal incontinence Rectal compliance Capacity Anal pressure Elderly Pelvic floor Aging Anorectal |
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