Investigation of the morphological structure of anal sphincter in patients with hemorrhoidal disease

Aim: In this study, it was aimed to examine the relationship between external/internal anal sphincter muscle which are surrounding the anal canal, puborectal muscle thickness and anal triangle area with stage IV hemorrhoidal disease and healthy individuals. At the same time, the relationship between the muscle structure around the anal canal and anal triangle area were examined according to the somatotype differences of all individuals included in the study. Material and method: A total of 151 volunteers, including 76 individuals diagnosed with stage IV hemorrhoidal disease and 75 healthy (control) individuals aged 18-65, were included in the study. The external/internal anal sphincter muscle and puborectal muscle thicknesses of all individuals were measured by three-dimesional endoanal ultrasonography. Internal and external anal sphincter muscle thicknesses were measured in four quadrants (right, left, anterior, posterior) at the level of the middle anal canal and the mean value of these measurements was taken. Puborectal muscle thickness was measured in two quadrants (right and left) at the upper side of anal canal and the average of these two measurements was taken. Anal triangle dimensions of individuals in both groups were measured using digital calipers. Anthropometric measurements of individuals were taken in accordance with the technique proposed by the International Biological Program (IBP). Results: It was observed that external anal sphincter muscle thickness was thicker in the patient group than in the control group in the right and posterior quadrants (p=0.046, 0.017 respectively). Internal anal sphincter muscle thickness was found to be thicker in patient group in the right and anterior quadrants (p=0.041, 0.006 respectively). There was no difference between groups in terms of thickness of m. puborectalis. When the muscle thickness and anal triangle area are compared to according to the somatotype characteristics of the all individuals, a statistically significant difference was found in external anal sphincter muscle thickness in terms of right and posterior quadrants and mean value (p=0.012; 0.035; 0.009 respectively). A statistically significant difference was found in the mean value of measurements taken in the right, anterior and posterior quadrants and four quadrants in internal anal sphincter muscle thickness (p=0.036; 0.007; 0.001; 0.004 respectively). A statistically significant difference was found between the groups in terms of anal triangle area (p=0.010). Conclusion: In conclusion, although the anal sphincter muscle thickness of the individuals in the patient group increased in some quadrants of the anal canal, there was no statistically significant difference between the two groups in terms of mean values. Therefore, it is thought that this change in the morphological structure of the anal sphincter muscles is not related to hemorrhoidal disease. Keywords: Hemorrhoidal disease, anal sphincter, anal triangle, 3D-endoanal USG, morphology