Academic literature on the topic 'External Anal Sphincter'
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Journal articles on the topic "External Anal Sphincter"
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Nielsen, M. B., O. Ø. Rasmussen, J. F. Pedersen, and J. Christiansen. "Anal Endosonographic Findings in Patients with Obstructed Defecation." Acta Radiologica 34, no. 1 (January 1993): 35–38. http://dx.doi.org/10.1177/028418519303400108.
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Anal endosonography, including measurements of anal sphincter size, was performed in 16 patients with obstructed defecation. The findings were compared with those at defecography and anal manometry. Patients with rectocele and intussusception had a normal endosonographic appearance. One patient with puborectalic spasm had normal sonography. There was no correlation between sphincter size and anal manometry. The external sphincter muscle was thicker and the cross-sectional area larger in patients with obstructed defecation than in healthy controls (p < 0.05). Two patients with sphincter spasm and impaired rectal emptying at defecography had clearly thickened internal sphincters which may be the cause of their defecatory disorder. Three patients with previous anal dilatation or hemorrhoidectomy had sphincteric defects. Anal endosonography may be considered in patients with obstructed defecation to identify patients with internal sphincter hypertrophy.
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Culver, P. J., and S. Rattan. "Genesis of anal canal pressures in the opossum." American Journal of Physiology-Gastrointestinal and Liver Physiology 251, no. 6 (December 1, 1986): G765—G771. http://dx.doi.org/10.1152/ajpgi.1986.251.6.g765.
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The purpose of the present investigation was to examine the role of the internal and external anal sphincters in the maintenance of resting pressures in the anal canal. The studies were performed in opossums anesthetized with alpha-chloralose. The radial and axial pressures in the anal canal were monitored using a continuously perfused catheter assembly. Electromyography of the external anal sphincter was monitored using bipolar tungsten hook electrodes. To examine the contribution of the external anal sphincter and surrounding skeletal muscle to the resting tone in the anal canal, pancuronium bromide was administered in a dose that abolished the electromyographic activity of the external anal sphincter muscle. The abolition of external anal sphincter activity did not modify the peak anal canal pressures, suggesting that these pressures are due to the internal anal sphincter. The alpha-adrenergic antagonist, phentolamine, did not modify the anal canal pressure, suggesting that basal internal anal sphincter pressure is not due to tonic adrenergic activity. Tetrodotoxin in a dose that produced obliteration of the anorectal reflex causing anal sphincter relaxation did not produce any change in the peak anal canal pressures. These studies show that the resting pressures in the anal canal of opossums are due to myogenic properties of the internal anal sphincter.
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Shafik, Ahmed, Olfat El Sibai, Ismail A. Shafik, and Ali A. Shafik. "Stress, Urge, and Mixed Types of Partial Fecal Incontinence: Pathogenesis, Clinical Presentation, and Treatment." American Surgeon 73, no. 1 (January 2007): 6–9. http://dx.doi.org/10.1177/000313480707300102.
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The authors investigated the hypothesis that partial fecal incontinence (PFI) had variable manifestations that can be categorized as different types of PFI with different pathogeneses and treatment. Anal and rectal pressures as well as external and internal anal sphincter electromyographic activity were recorded in 163 patients with PFI and in 25 healthy volunteers. Patients were treated with biofeedback or surgically. Three types of PFI were encountered: stress fecal incontinence (SFI; 55 patients), urge fecal incontinence (UFI; 72 patients), and mixed fecal incontinence (MFI; 36 patients). Anal pressure decreased in three groups in which MFI had the lowest pressure. A significant reduction in external anal sphincter electromyographic activity occurred in SFI, in internal anal sphincter electromyographic activity in UFI, and of both sphincters in MFI. Bio-feedback cured 36 of 55 patients and postanal repair cured 10 of 19 patients with SFI. Forty-eight of 72 patients with UFI responded to biofeedback and 16 of 24 responded to internal anal sphincter repair. Biofeedback failed in MFI patients. Twenty-four of 27 patients who consented to operative correction of the sphincteric defect were cured. Three types of PFI could be identified: SFI, UFI, and MFI. Each type has its own etiology and symptoms, and requires individual treatment. Biofeedback succeeded in treating the majority of SFI and UFI patients. Surgical correction of the anal sphincter was performed after biofeedback failure.
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Nielsen, M. B., C. Hauge, O. Ø. Rasmussen, M. Sørensen, J. F. Pedersen, and J. Christiansen. "Anal Sphincter Size Measured by Endosonography in Healthy Volunteers." Acta Radiologica 33, no. 5 (September 1992): 453–56. http://dx.doi.org/10.1177/028418519203300515.
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The anal sphincter muscles consist of the circular internal and external sphincters together with the sling-shaped associated puborectalis muscle. Ten men, 10 women with no vaginal deliveries, and 10 women with one or more vaginal deliveries were studied with anal endosonography using a 7 MHz multiplanar endoprobe. The thickness of the internal sphincter and the thickness, length, and cross-sectional area of the external sphincter were measured and related to age, sex, and parity. Reproducibility was assessed by similar measurements on different days in 10 volunteers. Anal sphincter size was the same in men and women and was not affected by the number of child births. Internal sphincter muscle thickness increased with age. Anal manometry and electromyography with an anal sponge were performed in all volunteers but the results did not correlate to any of the anal sphincter dimensions. Our conclusion is that although there are some limitations, endosonography can be used to determine the size of the anal sphincter muscles.
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Felt-Bersma, R. J. F., R. L. M. Strijers, J. J. W. M. Janssen, S. L. Visser, and S. G. M. Meuwissen. "The external anal sphincter." Diseases of the Colon & Rectum 32, no. 2 (February 1989): 112–16. http://dx.doi.org/10.1007/bf02553822.
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COURA, Marcelo de Melo Andrade, Silvana Marques SILVA, Romulo Medeiros de ALMEIDA, Miles Castedo FORREST, and João Batista SOUSA. "IS DIGITAL RECTAL EXAM RELIABLE IN GRADING ANAL SPHINCTER DEFECTS?" Arquivos de Gastroenterologia 53, no. 4 (December 2016): 240–45. http://dx.doi.org/10.1590/s0004-28032016000400006.
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ABSTRACT Background Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from extensive cases as depicted on 3D endoanal ultrasound, using a scoring sphincter defect and correlate anal tone to anal pressures. Methods Women with fecal incontinence were divided into two groups: small or extensive defects according to the ultrasound scoring system. Sensitivity, specificity, positive and negative predictive values of digital rectal examination in grading global and external sphincter defects were calculated. Anal tone at digital rectal examination was compared to resting and incremental pressures. Results A cohort of 76 consecutive incontinent women were enrolled. The median Wexner score was 9. Sixty-eight showed sphincter defects on 3D endoanal ultrasound. Anal tone at digital rectal examination was considered abnormal in 62 cases. Abnormal digital rectal examination showed a sensitivity of 90%, specificity of 27.78% in distinguishing small from extensive defects of both sphincters. Five out of eight women with no sphincter defects had only abnormal squeeze tone at digital rectal examination. Abnormal squeeze tone at digital rectal examination had a sensitivity of 65.31% in distinguishing small from extensive external anal sphincter defects. Digital rectal examination sensitivity increased linearly from small to extensive external anal sphincter defects (P=0.001). Women with abnormal resting tone had lower resting pressures than women with normal tone at digital rectal examination (P=0.0001). Women with abnormal squeeze tone had lower incremental pressures than women with normal tone at digital rectal examination (P=0.017). Conclusion Digital rectal examination had good sensitivity and poor specificity in discerning small from severe global anal sphincter defects. Moreover, digital rectal examination had fair sensitivity and poor specificity in grading external anal sphincter defects, and its best accuracy was on complete external anal sphincter lesions. Anal resting and squeeze tone were correlated to anal pressures.
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Paliyenko, R., and Z. Mishura. "The results of sphincterometry in patients after sorgion treatment of extrasphintery anal fistula." Journal of Education, Health and Sport 11, no. 10 (October 29, 2021): 311–19. http://dx.doi.org/10.12775/jehs.2021.11.10.029.
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More than 30% of patients with chronic paraproctitis have complex forms. They are most often complicated by external sphincter insufficiency due to deformation of the anal canal and scarring of the sphincters. The main principle of substantiation of surgical treatment of extrasphincteric pararectal fistulas is the individual choice of method in each particular patient. It is based on a comprehensive assessment of such factors as the etiology of the fistula, its distance from the edge of the anus, the relationship of the defect or fistula with the sphincter muscles apparatus, the severity of the scarring process, the functional state of the rectum.
Aim. Evaluation of the functional state of the sphincter apparatus of the rectum in patients with extrasphincteric pararectal fistulas in the preoperative, early and late postoperative periods.
Materials and methods. To determine the average indicators of anal sphincter function, basal tone and maximal compression force were measured using a sphincterometer "Sphinctometer STM-0164-SM" in 114 healthy individuals (68 men and 46 women) of different ages (16 to 80 years) who objectively had no signs of anal incontinence. In all patients, sphincterometry was preceded by a thorough proctological examination, and proctological pathology was excluded. Therefore, hemorrhoids or anal fissures, which lead to increased basal tone at rest, were excluded so as not to lead to falsified values.
Results. Indicators of the maximum compression force in the early postoperative period, ie the compression force of the external anal sphincter, in both groups were significantly lower than preoperative and ranged from 55 to 154 mm Hg, respectively. and from 63 to 137 mm Hg. This can be explained by the presence of a granulating wound in the pararectal tissue, edema and partial injury of the external anal sphincter during surgery.
In the late postoperative period, 6-12 months after surgery, the indicators of basal tone in both groups approached the preoperative indicators. In the main group, the study was performed in 22 patients. In these 22 patients, the tone of the internal anal sphincter did not differ significantly from the preoperative and ranged from 20 to 37 mm Hg. In the control group, in all 32 patients, the basal tone of the anal sphincter was significantly lower than before surgery - from 17 to 28 mm Hg. There were no clinical manifestations of incontinence at rest in either main or control groups.
In the late postoperative period in both groups a decrease in the maximum compression force of the external anal sphincter was revealed. In the main group the maximum compression force of the external anal sphincter varied from 71 to 186 mm Hg, and in the control group from 77 to 135 mm Hg, respectively.
Conclusion. Surgical treatment of patients with extrasphincteric pararectal fistulas significantly reduces the contractile function of the external anal sphincter in the postoperative period, regardless of the choice of surgery.
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López, Annika, Bengt Yngve Nilsson, Anders Mellgren, Jan Zetterström, and Bo Holmström. "Electromyography of the external anal sphincter." Diseases of the Colon & Rectum 42, no. 4 (April 1999): 482–85. http://dx.doi.org/10.1007/bf02234172.
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Wiesner, Antje, and Wolfgang H. Jost. "EMG of the external anal sphincter." Diseases of the Colon & Rectum 43, no. 1 (January 2000): 116–17. http://dx.doi.org/10.1007/bf02237259.
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MURAD-REGADAS, Sthela Maria, Iris Daiana DEALCANFREITAS, Francisco Sergio Pinheiro REGADAS, Lusmar Veras RODRIGUES, Graziela Olivia da Silva FERNANDES, and Jacyara de Jesus Rosa PEREIRA. "DO CHANGES IN ANAL SPHINCTER ANATOMY CORRELATE WITH ANAL FUNCTION IN WOMEN WITH A HISTORY OF VAGINAL DELIVERY?" Arquivos de Gastroenterologia 51, no. 3 (September 2014): 198–204. http://dx.doi.org/10.1590/s0004-28032014000300006.
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Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner’s score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US) em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal.
Dissertations / Theses on the topic "External Anal Sphincter"
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Adam-Castrillo, David. "Local Administration of Botulinum Toxin Type-B in the External Anal Sphincter of Horses Produces Transient Reduction of Peak Anal Pressure." Thesis, Virginia Tech, 2003. http://hdl.handle.net/10919/33927.
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Toxins produced by the Gram-positive bacteria Clostridium botulinum cause transient chemodenervation of mammalian muscle. The toxin binds to specific proteins within cholinergic presynaptic nerve terminals which regulate the release of acetylcholine in the synaptic space resulting is loss of muscle activation and function.
Local injections with botulinum toxins are currently used in humans for the treatment of disorders that benefit from prolonged neuromuscular blockade such as strabismus, blepharospasm, focal dystonias, spasticity, tremors, and anal fissures. Injections with botulinum toxin type A into the internal or external anal sphincter cause relaxation of the anal canal and allow healing of chronic anal fissures.
Perineal lacerations in mares, which occur during foaling often dehisce after surgical repair due to the high pressure across the incision resulting from accumulation of feces in the rectum. We hypothesized local injections of Clostridium botulinum type B toxin into the external anal sphincter could cause a decrease in anal pressures, thus reducing the incidence of dehiscence if used before surgical repair of perineal laceration in mares.
The purpose of this project was to determine the effects of BTB injection in the external anal sphincter in normal horses. Our hypothesis was that local injection of BTB would result in transient reduction of anal tone without causing clinical side effects. Peak and resting anal sphincter pressures of horses were measured with a custom made rectal probe connected to a pressure transducer. Pressures were measured before treatment and after injection with Clostridium botulinum type B toxin (BTB) or saline. Dose titration with 500, 1000, 1500 and 2500 units of BTB was completed. The horses' physical changes, behavior, and anal pressure were recorded. Injection of 1000 units of BTB produced significant reduction in peak anal pressure from days 2 to 84 when compared to control animals (P<0.05). Maximal effect of the toxin was observed within the first 15 days after injections followed by a slow return to baseline over 168 days. Injection in the anal sphincter with 2500 units of BTB in one horse produced signs of depression, generalized weakness, and dysphagia for 14 days. Clinical side effects were not observed in horses after injections with 500, 1000, or 1500 units of BTB.
In summary, local injections of botulinum toxin type-B in the external anal sphincter of horses caused transient relaxation of the anus and reduction of peak anal pressures. Systemic side effects were observed in one horse, which suggested a narrow dosage range to avoid toxicity. Further research to test the effects of botulinum toxin in clinical cases is needed to determine the full potential of this treatment modality.Master of Science
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Telford, Karen Jane. "A study of the innervation of the external anal sphincter using the strength-duration test." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.489641.
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Frappier, Brian Lee. "Localization of afferent and efferent innervation of the canine external anal sphincter muscle utilizing horseradish peroxidase neurohistochemical techniques /." The Ohio State University, 1988. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487592050227482.
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TODISCO, MASSIMILIANO. "External anal sphincter electromyographic patterns in multiple system atrophy: implications for diagnosis, clinical correlations, and novel insights into prognosis." Doctoral thesis, Università degli studi di Pavia, 2022. https://hdl.handle.net/11571/1468337.
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Multiple system atrophy (MSA) is a sporadic, progressive, adult-onset, neurodegenerative disorder characterized by autonomic dysfunction symptoms, parkinsonian features and cerebellar signs in various combinations. An early MSA diagnosis is of the utmost importance for a proper prevention and management of its potentially fatal complications leading to the poor prognosis of these patients. The current diagnostic criteria incorporate several clinical red flags and magnetic resonance imaging markers supporting MSA diagnosis. Nonetheless, especially in the early disease stage, it can be challenging to differentiate MSA from mimic disorders, in particular Parkinson’s disease (PD). Electromyography (EMG) of the external anal sphincter (EAS) represents a useful neurophysiological tool for the differential diagnosis, since it can provide indirect evidence of Onuf’s nucleus degeneration, which is a pathological hallmark of MSA. However, the diagnostic value of EAS EMG has been a matter of debate for three decades due to controversial reports in the literature. After a brief overview on the electrophysiological methodology, we critically analyzed the available knowledge on the diagnostic role of EAS EMG and discussed the conflicting evidence on the clinical correlations of neurogenic abnormalities found at EAS EMG. This study aimed to explore the diagnostic and prognostic value of a novel classification of EAS EMG patterns, and their correlations with clinical features and cardiovascular autonomic function in MSA. We retrospectively collected clinical data and EAS EMG findings in 72 patients with MSA and 21 with PD. Sixty-one and 56 MSA patients also underwent cardiovascular reflex tests and 24-hour blood pressure monitoring, respectively. We ascertained the survival times of 49 MSA patients who died during follow-up. Through evaluation of spontaneous activity, motor unit action potential (MUAP) duration and recruitment, we identified four EAS EMG patterns: normal findings (pattern I); mild neurogenic damage (pattern II); moderate neurogenic damage (pattern III); severe neurogenic damage (pattern IV). Pattern I was frequently observed in PD patients, while it was associated with prolonged survival when identified in a few MSA patients. Conversely, patterns II, III and IV were predominant in MSA. Subjects with MSA and EAS EMG abnormalities often showed fecal incontinence and urogenital symptoms, which were frequently present at disease onset when MUAP recruitment was impaired. Abnormal EAS EMG patterns correlated with MSA diagnosis (p < 0.001), with a sensitivity of 88.9%, specificity of 85.7%, and odds ratio of 48.0 (95% confidence interval: 11.5–199.8). Pattern IV was associated with the highest likelihood of MSA diagnosis (p < 0.001), and with the worst prognosis in the MSA cohort (vs. pattern I, p < 0.001; vs. pattern II, p = 0.001; vs. pattern III, p = 0.007). EAS EMG patterns were not related to motor impairment or cardiovascular autonomic function in MSA. In conclusion, the increasing severity of EAS EMG patterns paralleled diagnostic accuracy and survival in MSA. EAS EMG patterns correlated with symptom type at disease onset and with prevalence of urogenital symptoms and fecal incontinence. Prognostic findings of our novel classification of EAS EMG patterns could pave the way towards the implementation of this neurophysiological technique for survival prediction in MSA patients.
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BERTOLINO, JEAN-GUY. "Etude du controle des relations motrices entre la vessie et le sphincter anal externe : etude experimentale realisee chez le chat anesthesie." Aix-Marseille 2, 1992. http://www.theses.fr/1992AIX20835.
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SCRIBE, MYRIAM. "Etude du controle des relations motrices entre le sphincter anal externe et la vessie : etude experimentale chez l'homme." Aix-Marseille 2, 1993. http://www.theses.fr/1993AIX20840.
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Abysique, Anne. "Etude de la commande nerveuse spinale et supraspinale du sphincter anal externe : implication dans l'alternance de la miction et de la défécation." Aix-Marseille 3, 1992. http://www.theses.fr/1992AIX30079.
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Yu-Hui and 黃玉慧. "Effect of anal stretch and botulinum toxin injection on detrusor-external sphincter dyssynergia: evaluated by integrated electromyography." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/90403439168643130385.
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博士中山醫學大學
醫學研究所
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Detrusor-external sphincter dyssynergia (DESD) is a common cause of bladder outlet obstruction in SCI patients and associated with many urologic complications. Sphincterotomy is currently the main treatment of DESD, but its irreversability, high failure rate and high re-operation rate make it not so acceptable to most SCI patients. The other treatment choices are urethral stent, urethral ballon dilatation, oral medication, pudendal nerve block, anal stretch and botulinum toxin injection. Among these methods, anal stretch and botulinum toxin injection are two methods that are reversible, easy to perform, and with no serious side effects. Anal stretch was reported to effectively inhibit activity of external urethral sphincter in patients with DESD. However the opinions of effects on detrusor are controversial and there were no further studies since 1981. Botulinum –A toxin injection to the external urethral sphincter could reduce post-voiding residual urine amounts and improve urodynamic parameters (detrusor pressure and urethral pressure) in previous reports. However these parameters could be influenced by other factors and the direct evaluation of urethral sphincter activity from electromyography was only descriptive without quantification in these studies. In this study, we further investigated these two treatments by using integrated electromyography (IEMG) to quantify the activity of external urethral sphincter. With direct evidences of effect, we could choose the prompt patients to receive these treatments, then we can improve the clinical efficiency. In the results of anal stretch, it could significantly reduce the activity of external urethral sphincter showed on IEMG (the mediums of reduction percentage during 1- 15 seconds and 16-30 seconds were 33% and 35%). The urethral pressure was also reduced but the difference was significant only between the data before stretch and at 16-30 seconds after stretch. The detrusor pressure did not change significantly. Patients with different ASIA impairment scale had different responses: the more completeness of neurologic injury (Grade A and B in ASIA impairment scale), the better effect of anal stretch. In the results of botulinum toxin injection, there were significant reductions in IEMG and static and dynamic urethral pressure (mean reduction percentages were 24.4, 20.6, and 17.3, respectively) but not in maximal detrusor pressure and leak point pressure at one month after treatment. PVR was significantly decreased at the all of the evaluation periods (mean reduction percentages were 41.2, 32.6, 24.6, and 15.8, at month 1, 2, 3, and 6 after treatment). In the sub-group analysis, patients with good effect had significantly lower baseline IEMG (p<0.05). In conclusions, IEMG is a good tool to evaluate the effect of anal stretch and botulinum toxin injection in treating DESD. It could quantify the activity of external urethral sphincter thus we could know the net effect of these interventions. Besides, it could also help in subgroup analysis that we could decide the suitable subjects for a specific treatment.
Books on the topic "External Anal Sphincter"
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Fowle, Adrian J. Clinical neurophysiology of the pelvic floor. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0017.
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This chapter offers a personal view of a service providing pelvic floor studies. It first debunks the myths that put patients and doctors off. A practical approach is outlined to performing the most worthwhile studies from referral to report. Care of the patient and understanding of the anatomy and physiology are emphasized as necessary for the performance of the studies. The most useful studies, examination of the external anal sphincter, and either bulbocavernosus reflex or pudendal somatosensory evoked potentials, are highlighted. Finally, the conditions in which these studies may be useful are discussed, including cauda-equina syndrome, post-partum incontinence, and neurological conditions.
Book chapters on the topic "External Anal Sphincter"
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Haghighi, Siavash S. "Motor evoked potentials from external anal and urethral sphincter muscles by transcranial cortical stimulation during surgery." In Intraoperative Monitoring of Neural Function, 434–38. Elsevier, 2008. http://dx.doi.org/10.1016/s1567-4231(07)08030-6.
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