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Fig. 5A —Anal sphincter defects shown in four patients. Axial transperineal image in 27-year-old woman with prior obstetric trauma shows defect in hypoechoic ring of internal anal sphincter from 10- to 1-o'clock positions. Smaller hypoechoic defect is seen in echogenic tissue of external anal sphincter from 11- to 12-o'clock positions. This very clear defect in both sphincters suggests that surgical repair would be potentially possible.