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Journal articles on the topic 'External Anal Sphincter'

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Published: 14 March 2023

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1

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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2

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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3

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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4

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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5

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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6

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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7

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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8

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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9

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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10

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.

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11

Telford, K. J., A. S. M. Ali, K. Lymer, G. L. Hosker, E. S. Kiff, and J. Hill. "Fatigability of the External Anal Sphincter in Anal Incontinence." Diseases of the Colon & Rectum 47, no. 5 (May 2004): 746–52. http://dx.doi.org/10.1007/s10350-003-0122-6.

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12

Youssef, Ashraf Talaat. "To Evaluate and Explain the Consequences of Abnormal Anal Sphincter Morphology Using the 3-Dimensional Endosonography." Advances in Radiology 2014 (November 20, 2014): 1–7. http://dx.doi.org/10.1155/2014/131032.

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The Objective of the Study. To evaluate and explain the consequences of different morphological abnormalities of anal sphincters including the sphincter damage and its extent using the 3-dimensional endosonography. Material and Methods. 56 patients suffering from fecal incontinence all were subjected to analysis of patient symptoms, scoring the severity of symptoms, digital examination, electromyography, and 3D endoanal ultrasonography. Results. 5 patients showed intact anal sphincters and puborectalis muscle. 4 patients found with thick IAS > 4 mm, 4 patients with thin IAS < 2 mm. 3 patients with thin EAS, 12 patients with IAS defects, 15 patients with EAS defects, 8 patients with combined IAS and EAS defects, 2 patients with puborectalis muscle defects and 3 patients with high levels transsphincteric perianal fistulas. Conclusion. No significant relationship was observed between sphincter damage except for combined internal and external sphincter injury and the severity score of FI symptoms. Puborectalis muscle injury and abnormal sphincter thickness are unlikely causes of severe FI.

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13

Фоменко, О. Ю., Ю. А. Шелыгин, Г. В. Порядин, А. Ю. Титов, Е. А. Берсенева, А. А. Мудров, and С. В. Белоусова. "The muscle fatigue of external anal sphincter in patients with anal incontinence." ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia», no. 3() (June 7, 2017): 69–75. http://dx.doi.org/10.25557/0031-2991.2017.03.69-75.

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Цель - изучение зависимости утомляемости наружного сфинктера от наличия анальной инконтиненции и степени выраженности. Методы. Для выяснения зависимости утомляемости от наличия анальной инконтиненции обследовано 203 пациента с жалобами на недержание различных компонентов кишечного содержимого: 90 мужчин (44,3%), средний возраст 44,8 ± 14,7 года и 113 женщин (55,7%), средний возраст 46,4 ± 15,2 года. Для определения нормативных величин отобраны 53 пациента с полипами ободочной кишки, без клинико-инструментальных признаков анальной инконтиненции. В состав группы вошли 23 женщины (43,4%), средний возраст 51,4 ± 11,1 года и 30 мужчин (56,6%), средний возраст 65,1 ± 15,9 года. Использован разработанный в ФГБУ ГНЦК им. А.Н. Рыжих Минздрава России метод комплексной сфинктерометрии неперфузионным датчиком водного наполнения на приборе WPM Solar GI. Результаты и обсуждение. Получены нормативные показатели теста на выносливость наружного сфинктера. Не выявлено корреляции между степенью недостаточности анального сфинктера (по показателям давления в анальном канале) и одним из параметров утомляемости (временем падения давления на 50%), вероятнее всего из-за посттравматического характера недостаточности анального сфинктера. Предполагается продолжение работы по изучению утомляемости при различном генезе анальной инконтинеции. The article presents materials on the muscle fatigue of the external sphincter in the norm and in patients with anal sphincter failure. The purpose. To determine the dependence of external sphincter fatigue on the presence of anal incontinence and its degree. Methods. 203 patients with complaints of incontinence of various components of intestinal contents were examined (90 male (44.3%), mean age is 44.8 ± 14.7 years, 113 female (55.7%) mean age is 46.4 ± 15.2 years) to determine the dependence of fatigue on the presence of anal incontinence. 53 patients with colon polyps without clinical and instrumental signs of anal incontinence were selected for the determination of normal values. 23 female (43.4%), mean age is 51.4 ± 11.1 years; 30 male (56.6%), mean age is 65.1 ± 15.9 years. For the study, we used the method of complex sphincterometry developed in State Scientific Centre of Coloproctology on the device WPM Solar GI (MMS, The Netherlands) with a nonperfusion water sensor. Results. We have received normal values for external sphincter endurance test. At the same time, there was no correlation between the degree of anal sphincter failure (in terms of pressure in the anal canal) and one of the fatigue parameters (the time of the pressure drop by 50%), most likely because of the post-traumatic nature of anal sphincter failure. We plan to continue studying fatigue with a different genesis of anal incontinence. Conclusion. We plan to continue studying fatigue with a different genesis of anal incontinence.

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14

Nielsen, M. B., and J. F. Pedersen. "Changes in the Anal Sphincter with Age." Acta Radiologica 37, no. 1P1 (January 1996): 357–61. http://dx.doi.org/10.1177/02841851960371p175.

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Purpose: To describe the changes in the endosonographic appearance of the anal sphincter muscles with age. Material and Methods: Fifty subjects (age range 22–85 years) with no history of anorectal disease or surgery were studied with anal endosonography. The thickness of the internal and external anal sphincter was registered and correlated to age. For the internal sphincter, which is often asymmetric, the maximum and minimum thicknesses were measured at any part of the circumference (except anteriorly for anatomic reasons) and also in the lateral positions. Results: A significant positive correlation with age was found for all maximum, minimum, and average internal sphincter thicknesses. Moreover, the echogenicity of the internal sphincter changed with age as the sphincter muscle became more echogenic. There was no significant correlation between external sphincter thickness and age. Conclusion: Knowledge of the normal variation of the internal sphincter thickness with age is important since endosonography may be used to identify patients with hypertrophy of the internal sphincter. Currently, we consider maximal thicknesses above 4 mm to be abnormal in patients under 50 years of age, whereas in patients aged at least 50 years thicknesses of 5 mm or more are considered abnormal.

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15

Briel, J. W., L. M. de Boer, W. C. J. Hop, and W. R. Schouten. "Clinical outcome of anterior overlapping external anal sphincter repair with internal anal sphincter imbrication." Diseases of the Colon & Rectum 41, no. 2 (February 1998): 209–14. http://dx.doi.org/10.1007/bf02238250.

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16

Chan, Miranda K. Y., and Joe J. Tjandra. "Sacral Nerve Stimulation for Fecal Incontinence: External Anal Sphincter Defect vs. Intact Anal Sphincter." Diseases of the Colon & Rectum 51, no. 7 (July 2008): 1015–25. http://dx.doi.org/10.1007/s10350-008-9326-0.

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17

Nockolds, C. L., G. L. Hosker, and E. S. Kiff. "Fatigue rate of the external anal sphincter." Colorectal Disease 14, no. 9 (August 22, 2012): 1095–100. http://dx.doi.org/10.1111/j.1463-1318.2011.02901.x.

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18

Shafik, A. "Injured external anal sphincter in erectile dysfunction." Andrologia 33, no. 1 (January 29, 2001): 35–41. http://dx.doi.org/10.1046/j.1439-0272.2001.00408.x.

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19

Haadem, Knut, Lennart Ling, Mårten Fernö, and Hans Graffner. "Estrogen receptors in the external anal sphincter." American Journal of Obstetrics and Gynecology 164, no. 2 (February 1991): 609–10. http://dx.doi.org/10.1016/s0002-9378(11)80032-3.

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20

Shafik, A., Gamal El-Din, O. El-Sibaei, Abdel Hamid, and B. El-Said. "Involuntary Action of the External Anal Sphincter." European Surgical Research 24, no. 3 (1992): 188–96. http://dx.doi.org/10.1159/000129206.

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21

Rosenberg, Jacob, and Henrik Kehlet. "Early discharge after external anal sphincter repair." Diseases of the Colon & Rectum 42, no. 4 (April 1999): 457–59. http://dx.doi.org/10.1007/bf02234166.

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22

Weber, J., F. Beuret-Blanquart, P. Ducrotte, J. Y. Touchais, and P. Denis. "External anal sphincter function in spinal patients." Diseases of the Colon & Rectum 34, no. 5 (May 1991): 409–15. http://dx.doi.org/10.1007/bf02053693.

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23

Brodén, G., A. Dolk, C. Frostell, B. Nilsson, and B. Holmström. "Voluntary relaxation of the external anal sphincter." Diseases of the Colon & Rectum 32, no. 5 (May 1989): 376–78. http://dx.doi.org/10.1007/bf02563687.

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24

Li, Long, Jin-Zhe Zhang, Guo-Wei Lu, Guo-Rei He, and Xiao-Hong Lui. "Damaging effects of anal stretching on the external anal sphincter." Diseases of the Colon & Rectum 39, no. 11 (November 1996): 1249–54. http://dx.doi.org/10.1007/bf02055118.

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25

MURAD-REGADAS, Sthela Maria, Francisco Sergio P. REGADAS FILHO, Erico de Carvalho HOLANDA, Lara Burlamaqui VERAS, Adjra da Silva VILARINHO, and Manoel S. LOPES. "CAN THREE-DIMENSIONAL ANORECTAL ULTRASONOGRAPHY BE INCLUDED AS A DIAGNOSTIC TOOL FOR THE ASSESSMENT OF ANAL FISTULA BEFORE AND AFTER SURGICAL TREATMENT?" Arquivos de Gastroenterologia 55, suppl 1 (August 6, 2018): 18–24. http://dx.doi.org/10.1590/s0004-2803.201800000-42.

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ABSTRACT BACKGROUND: There is no a clear knowledge concerning the division of any part of the anal sphincter complex and the effect of this procedure on the function of the anal canal during the treatment of perianal fistula. OBJECTIVE: To evaluate the usefulness of 3D anorectal ultrasound in the assessment of anal fistula, quantifying the length of the sphincter muscle to be transected, selecting patients for different approaches and identifying healing, failure or recurrence after the surgical treatment. METHODS: A prospective study included patients with primarily cryptogenic transsphincteric anal fistula assessed by fecal Incontinence score, tri-dimensional anorectal ultrasound and anal manometry before and after surgery. Based on 3D-AUS, patients with ≥50% external sphincter or external sphincter+puborectalis muscle involvement in males and ≥40% external sphincter or external sphincter+puborectalis muscle in females were referred for the ligation of the intersphincteric tract (LIFT) or seton placement and subsequent fistulotomy; and with <50% involvement in males and <40% in females were referred to one-stage fistulotomy. After surgery, the fibrosis (muscles divided) and residual muscles were measured and compared with the pre-operative. RESULTS: A total of 73 patients was included. The indication for the LIFT was significantly higher in females (47%), one-stage fistulotomy was significantly higher in the males (46%) and similar in seton placement. The minor postoperative incontinence was identified in 31% of patients underwent sphincter divided and were similar in both genders. The 3D-AUS identified seven failed cases. CONCLUSION: The 3D ultrasound was shown to be an effective method in the preoperative assessment of anal fistulas by quantifying the length of muscle to be divided, as the results were similar at the post-operative, providing a safe treatment approach according to the gender and percentage of muscle involvement. Additionally, 3D ultrasound successfully identified the healing tissue and the type of failure or recurrence.

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Konoplitskiy, V. S., and R. V. Shavliuk. "Is an empirical approach to performing access in pediatric surgery in children safe?" Paediatric Surgery. Ukraine, no. 4(69) (December 30, 2020): 43–50. http://dx.doi.org/10.15574/ps.2020.69.43.

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Objective: to determine the topical localization of the structural components of the anal sphincter and to formulate the basic postulates of the formation of safe anatomical access in pilonidal disease surgery in children. Materials and methods: the study was conducted on the corpses of 10 children who had no lifelong pathology of the sacrococcygeal region and pelvis aged 12 to 17 years, including 5 girls and 5 boys. Soft tissue columns 1 cm wide and up to 5 cm long were prepared at a distance of 1 cm from the anus by 12 h, 3 h, 6 h and 9 h according to the dial in the back position. After preparation and fixation of the drugs, their staining was performed and cross-sections of anal sphincters 5–7 μm thick were made. The analysis of the received morphometric data is carried out. The results of the study: it was found that the cross-sectional area of the bundle of muscle fibers of the external sphincter of the anus on average in adolescents ranged from 448±32 μm2 to 412±24 μm2. The diameter of its muscle fibers was 13.02±1.56 μm, and the bulk density of muscle fibers is 96.12±1.34%. Regarding the length of the internal anal sphincter, it was found that it is almost the same in different areas and is 1.3±0.03 at the level of 3 and 12 hours, 1.3±0.07 at the level of 6 hours and 1.2±0.03 at the level of 9 hours. In the study of the linear dimensions of the length of different portions of external anal sphincter in certain places of the biopsy revealed a predominance of parameters that were determined at 6 hours, respectively, 5.7±0.06 cm against 4.3±0.04 cm at 3 hours, and 12 hours, respectively 5.1±0.06 cm against 4.3±0.03 cm at 9 years. The thickness of the external sphincter of the anus at 6 hours, respectively 26.7±0.61 mm against 18.5±0.19 mm at 3 hours, (<0.01) and 12 hours, respectively 23.9±0.33 mm against 18.4±0.19 mm at 9 hours. Diameters of separate muscular fibers and bundles were explored. It is established that the average diameter of a muscle fiber makes 13.7±0.18 microns, and the average diameter of a muscular bundle is equal to 435.9±5.15 microns. Conclusions. 1. Existing anatomical descriptions of anal sphincters need in the modern world more thorough research to prevent their injury during surgery. 2. The external anal sphincter has the spatial form of the three-storeyed oval structure extended in the front-back direction with dominance of the caudal muscular portion. 3. When performing radical surgical interventions for pilonidal disease in children by cleft-lift method, it is necessary to complete the edge of surgical access at a distance of not less than 3 cm to the edge of the anal sphincter. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pilonidal disease, children, morphometry, surgical intervention.

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Tuttle, Lori J., Ali Zifan, Catherine Sun, Jessica Swartz, Sophia Roalkvam, and Ravinder K. Mittal. "Measuring length-tension function of the anal sphincters and puborectalis muscle using the functional luminal imaging probe." American Journal of Physiology-Gastrointestinal and Liver Physiology 315, no. 5 (November 1, 2018): G781—G787. http://dx.doi.org/10.1152/ajpgi.00414.2017.

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The functional luminal imaging probe (FLIP) has been used to measure the distensibility of the anal canal. We hypothesized that with increasing distension of the anal canal with FLIP there will be an increase in length of the anal sphincter muscle allowing measurement of the length-tension function of anal sphincter and puborectalis muscles (PRM). We studied 14 healthy nulliparous women. A custom-designed FLIP bag (30-mm diameter) was placed in the vagina and then in the anal canal, distended in 10-ml steps with volumes ranging from 30 to 90 ml. At each volume, subject performed maximal voluntary squeezes. Length-tension measurements were also made with a manometric probe system. Tension was calculated (pressure × radius) in Newtons per meter using a custom software program. Peak tensions at different FLIP volumes were compared with the manometric data. No change in the luminal CSA was noted at low fluid volumes; the sphincter muscles were able to fully collapse the FLIP bag within the anal canal/vagina even at rest. At larger volumes, with each squeeze there was an increase in the bag pressure and reduction in the cross-sectional area, which represents concentric contraction of the muscle. Both rest and squeeze tension increased with the increase in volume in the anal as well as vaginal canal indicating that the external anal sphincter and puborectalis muscles produce more tension when lengthened. FLIP device, which has been used to describe the distensibility of the anal canal can also provide information on the length-tension function of the anal sphincters and PRM. NEW & NOTEWORTHY The functional luminal imaging probe (FLIP) has been used to describe the distensibility of the anal canal. This report is the first to describe the use of the FLIP in the vaginal canal and the anal canal to provide information on the length-tension function of the anal sphincter and puborectalis muscles, which may provide clinicians with additional information regarding the active components of muscle contraction involved in the anal closure function.

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Sorensen, M., T. Tetzschner, O. O. Rasmussen, and J. Christiansen. "Relation between electromyography and anal manometry of the external anal sphincter." Gut 32, no. 9 (September 1, 1991): 1031–34. http://dx.doi.org/10.1136/gut.32.9.1031.

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Papachrysostomou, M., N. R. Binnie, and A. N. Smith. "Relation between electromyography and anal manometry of the external anal sphincter." Gut 33, no. 5 (May 1, 1992): 718. http://dx.doi.org/10.1136/gut.33.5.718.

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Bashirov, S. R., M. N. Trifonov, A. A. Gaidash, and V. I. Tikhonov. "STRUCTURE OF THE ANAL CANAL AND ANAL SPHINCTER DOGS IN NORM AND AFTER PROCTECTOMY WITH BRINGING DOWN THE COLON." Bulletin of Siberian Medicine 14, no. 6 (December 28, 2015): 25–32. http://dx.doi.org/10.20538/1682-0363-2015-6-25-32.

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With gistostereometry study the structure of the anal canal and anal sphincter dogs in norm and after proctectomy with bringing down the colon, forming neoanus and neosphinkter. The artificial sphincter is the inevitable process of smooth muscle atrophy can save at least half the volume of smooth muscle, similar to the number in the internal sphincter needed to restore function after holding involuntary proctectomy. Neoanus of mucous and submucosal colon relegated acquired typical smooth relief with the advent of the vertical pleats on the type of anal columns of Morgagni and with the perianal skin was closely associated with the subcutaneous portion of the external sphincter smooth muscle and an artificial sphincter. Thus, the experimental model of the internal sphincter and neoanus created by bringing down the mucous and the formation of smooth cuffs, very similar in quantitative and qualitative terms, the structure of the anal canal and anal sphincter dogs and can be used in clinical practice.

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31

Wahyuningtyas, Riska, Eighty Mardiyan Kurniawati, Budi Utomo, Gatut Hardianto, Hari Paraton, Tri Hastono, and Djoko Kuswanto. "Obstetrics and gynecology residents’ satisfaction and self-confidence after an anal sphincter injury simulation-based workshop in Indonesia: a pre- and post-intervention comparison study." Journal of Educational Evaluation for Health Professions 19 (February 14, 2022): 4. http://dx.doi.org/10.3352/jeehp.2022.19.4.

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Purpose: Obstetric anal sphincter injury is one of the most common complications during delivery. Simulation models with manikins can be used as an effective medical learning method to improve students’ abilities before encountering patients. The present study aimed to describe the development of an anal sphincter injury model and to assess residents’ satisfaction and self-confidence after a perineal repair workshop with an anal sphincter injury simulator in Indonesia.Methods: This was a cross-sectional study with evaluation of outcomes before and after the workshop. We created a silicone-latex simulation anal sphincter injury model. Then, we validated this simulation and used it as a simulation model for the workshop. We asked residents about their satisfaction with repairing anal sphincter injuries using a simulation model and residents’ self-confidence when practicing anal sphincter injury repair.Results: All residents felt the simulation-based workshop was valuable (100%). Most of the scores for the similarity of the simulation model were good (about 8 out of maximum 10). The self-assessment of confidence was measured before and after the workshop. Overall self-confidence increased significantly after the workshop in identifying the external sphincter ani (EAS) (P=0.031), suturing the anal mucosa (P=0.001), suturing the internal sphincter ani (P=0.001), suturing the EAS (P<0.001), and evaluating the sphincter ani tone (P=0.016).Conclusion: The anal sphincter injury simulator improved residents’ self-confidence in identifying the EAS, suturing the anal mucosa, suturing the internal sphincter ani, suturing the EAS, and evaluating sphincter ani tone.

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Miyajima, N., S. Kodaira, T. Teramoto, T. Ishii, T. Takabayashi, and O. Abe. "Histological study of the human external anal sphincter." Nippon Daicho Komonbyo Gakkai Zasshi 41, no. 3 (1988): 267–72. http://dx.doi.org/10.3862/jcoloproctology.41.267.

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Bogduk, Nikolai. "ISSUES IN ANATOMY: THE EXTERNAL ANAL SPHINCTER REVISITED." ANZ Journal of Surgery 66, no. 9 (September 1996): 626–29. http://dx.doi.org/10.1111/j.1445-2197.1996.tb00834.x.

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34

Parmar, Nina, and Richard M. Day. "Appropriately sized bioengineered human external anal sphincter constructs." Surgery 157, no. 1 (January 2015): 177–78. http://dx.doi.org/10.1016/j.surg.2014.05.025.

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35

Wai, Clifford Y., and R. Ann Word. "Contractile properties of the denervated external anal sphincter." American Journal of Obstetrics and Gynecology 200, no. 6 (June 2009): 653.e1–653.e7. http://dx.doi.org/10.1016/j.ajog.2009.01.004.

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36

Ishii, M., S. Yuen, S. Yamaguchi, H. Morita, S. Saito, M. Oota, K. Morimoto, T. Okumoto, and M. Hashimoto. "Preoperative Assessment of External Anal Sphincter Invasion and Para-external Anal Sphincter Invasion in Rectal Cancer Using Magnetic Resonance Imaging." Nippon Daicho Komonbyo Gakkai Zasshi 59, no. 7 (2006): 367–72. http://dx.doi.org/10.3862/jcoloproctology.59.367.

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37

Rajasekaran, M. Raj, Yanfen Jiang, Valmik Bhargava, Sonia Ramamoorthy, Richard L. Lieber, and Ravinder K. Mittal. "Sustained Improvement in the Anal Sphincter Function Following Surgical Plication of Rabbit External Anal Sphincter Muscle." Diseases of the Colon & Rectum 54, no. 11 (November 2011): 1373–80. http://dx.doi.org/10.1097/dcr.0b013e31822d0333.

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38

Krier, J., and T. Adams. "Quantification of axial forces in rectum-anal canal of the cat." American Journal of Physiology-Gastrointestinal and Liver Physiology 250, no. 2 (February 1, 1986): G260—G265. http://dx.doi.org/10.1152/ajpgi.1986.250.2.g260.

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A newly developed probe was used to measure in vivo axial forces in the rectum-anal canal of the anesthetized cat. Spontaneous contractions of the smooth muscle of the internal anal sphincter were recorded, as were neurally evoked contractions of striated muscle of the external anal sphincter. Bilateral electrical stimulation (1-10 V, 1-5 Hz, 0.05 ms duration) of motor axons in pudendal nerves elicited two responses. One was synchronous phasic contractions of skeletal muscle fibers of the external anal sphincter that were not abolished by atropine but were by gallamine trithiodide. They occurred at short latencies (1-2 ms) and were mediated through low-threshold (1-3 V, 0.05 ms duration) efferent axons in the pudendal nerves. Contraction times ranged from 45 to 60 ms, and contraction duration ranged from 100 to 160 ms. The second response was a progressive elevation in tone of the anal canal due to contractions either of the smooth muscle of the rectum and/or that of the internal anal sphincter. The elevation in smooth muscle tone concomitant with pudendal nerve stimulation may be due to reflex activation of cholinergic neural pathways, since the response was abolished by atropine.

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39

Muhabbatov, D. K., M. Q. Gulov, S. I. Rasulova, Sh R. Amirov, and J. J. Davlatov. "Insufﬁciency of the anal sphinter in women." Health care of Tajikistan, no. 2 (July 28, 2021): 70–75. http://dx.doi.org/10.52888/0514-2515-2021-349-2-70-75.

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Aim. To analyze and assess the clinical course and changes under instrumental-functional examination (MRI) in the muscles of the obturator apparatus of the rectum in women with anal sphincter insufﬁciency (ASI).Material and methods. Clinical and instrumental research methods, as well as modern scales for assessing ASI (Wexner score scale), were used in the current study.Results and discussion. The study showed that 110 out of 228 patients with anal sphincter deﬁciency showed only an organic form of ASI, and 118 (51.8%) had a mixed form (organic and functional). This study shows that the degree of postpartum perineal rupture depends on the factors producing the damage to the pelvic ﬂoor muscles.Conclusion. Analysis of the clinical course of ASI in women showed that gender-related factors in 51.8% of cases contributed to the development of a mixed form of the disease. Functional research methods showed that along with the external and internal sphincters of the rectum, the pubo-rectal muscle is damaged in patients with ASI, which should be taken into account when choosing a treatment strategy for the mixed form of ASI.

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40

Deffieux, Xavier, Katelyne Hubeaux, Raphaël Porcher, Samer Sheikh Ismael, Patrick Raibaut, and Gérard Amarenco. "External intercostal muscles and external anal sphincter electromyographic activity during coughing." International Urogynecology Journal 19, no. 4 (October 13, 2007): 521–24. http://dx.doi.org/10.1007/s00192-007-0473-y.

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41

Berg, M. R., H. Gregussen, and Y. Sahlin. "Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter." Techniques in Coloproctology 23, no. 12 (November 26, 2019): 1163–72. http://dx.doi.org/10.1007/s10151-019-02122-7.

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Abstract Background Sphincteroplasty is one of the treatment options for anal incontinence following obstetric injury. The aim of the study was to evaluate the long-term effect of sphincteroplasty with separate suturing of the internal and the external anal sphincter on anal continence. Methods A retrospective study was conducted on women who had sphincteroplasty for treatment of anal incontinence following obstetric injury. Women operated between January 1, 2011 and December 31, 2014 at Sykehuset Innlandet Hospital Trust Hamar, were invited to answer a questionnaire and participate in a clinical examination, including endoanal sonography. Results 111 (86.7%) women participated. Median postoperative follow-up was 44.5 months, and 63.8% of the participants experienced an improvement of at least three points in the St. Mark’s incontinence score. Fecal urgency and daily fecal leakage persisted in 39.4% and 6.4% of the participants, respectively. The internal anal sphincter improvement persisted in 61.8% of the participants, and there was a median reduction of their St. Mark’s score of 6.0 points between the preoperative value and the value at long-term follow-up. There was no significant change in the St. Mark’s score of patients with persistent dehiscence of the internal anal sphincter. Conclusions Sphincteroplasty, with separate suturing of the internal sphincter resulted in continence for stool maintained for at least 3 years in the majority of the patients, while there was an improvement in continence in nearly two-thirds.

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Herdmann, J., K. Bielefeldt, and P. Enck. "Quantification of motor pathways to the pelvic floor in humans." American Journal of Physiology-Gastrointestinal and Liver Physiology 260, no. 5 (May 1, 1991): G720—G723. http://dx.doi.org/10.1152/ajpgi.1991.260.5.g720.

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The motor innervation of the pelvic floor plays a major role in defecation disorders such as fecal incontinence. It consists of central motor pathways and peripheral nerve fibers. Transcranial magnetoelectric stimulation of the brain and magnetoelectric stimulation of the lumbosacral motor roots were performed in 10 healthy volunteers. Motor evoked potentials were recorded from the external anal sphincter. This procedure allowed differentiation between a predominantly central and a solely peripheral component of the motor innervation of the external and sphincter. To compare these recordings with well-established data, motor evoked potentials were also recorded from the anterior tibial muscle. The central motor conduction time was 20.9 +/- 2.4 ms to the external anal sphincter and 14.8 +/- 2.3 ms to the anterior tibial muscles. Central motor conduction velocities were 40.7 +/- 5.2 and 55.5 +/- 7.6 m/s, respectively. This showed that conduction in the central fibers to the external anal sphincter was significantly slower than in those to the anterior tibial muscle. We conclude 1) that magnetoelectric stimulation allows differentiation between central and peripheral portions of the motor innervation of the pelvic floor, and 2) that central motor pathways innervating the pelvic floor differ significantly in their physiological properties from those innervating limb muscles.

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Andromanakos, Nikolaos, Dimitrios Filippou, Nikolaos Karandreas, and Alkiviadis Kostakis. "Puborectalis muscle and External Anal Sphincter: a functional unit?" Turkish Journal of Gastroenterology 31, no. 4 (May 12, 2020): 342–43. http://dx.doi.org/10.5152/tjg.2020.19208.

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44

Nockolds, C. L., G. L. Hosker, and E. S. Kiff. "Compound muscle action potential of the external anal sphincter." Colorectal Disease 15, no. 10 (October 2013): 1289–94. http://dx.doi.org/10.1111/codi.12315.

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45

SHAFIK, A. "PHYSIOANATOMIC ENTIRETY OF EXTERNAL ANAL SPHINCTER WITH BULBOCAVERNOSUS MUSCLE." Archives of Andrology 42, no. 1 (January 1999): 45–54. http://dx.doi.org/10.1080/014850199263048.

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46

Herdmann, J., P. Enck, P. Zacchi-Deutschbein, and U. Ostermann. "Speed and pressure characteristics of external anal sphincter contractions." American Journal of Physiology-Gastrointestinal and Liver Physiology 269, no. 2 (August 1, 1995): G225—G231. http://dx.doi.org/10.1152/ajpgi.1995.269.2.g225.

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The principle of isochronism reflects constant contraction time for varying strengths of muscle contraction. This principle was studied for the innervation of the pelvic floor in humans using motor-evoked potentials (MEPs) and evoked pressure curves (EPCs) from the external anal sphincter muscle (EAS). MEPs and EPCs were simultaneously recorded after transcranial magnetic stimulation of the motor cortex. Voluntary contractions were also studied. Contraction times of the EAS were significantly longer in voluntary contractions (mean, 237 ms) than in EPCs (mean, 90 ms). Depending on either mode of contraction, contraction times varied only slightly despite a wide range of contraction strengths. It is shown that the contractile behavior of the EAS is a function of slow- and fast-twitch muscle fiber distribution and that the principle of isochronism governs motor performance not only of limb muscles but also of the EAS. There exists a unique optimal working range of each muscle to meet its individual function. Disturbance of this principle results in a less efficient contraction with either inappropriate basic tone or disturbed reflex activation in the EAS. Both are possible causes of incontinence.

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Stewart, Amanda M., Mark S. Cook, Keisha Y. Dyer, and Marianna Alperin. "Structure–function relationship of the human external anal sphincter." International Urogynecology Journal 29, no. 5 (July 8, 2017): 673–78. http://dx.doi.org/10.1007/s00192-017-3404-6.

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Schweiger, Heinz Bacher, Herwig Cer, Wolfgang. "Perianal Endometriosis with Involvement of the External Anal Sphincter." European Journal of Surgery 165, no. 6 (June 10, 1999): 615–17. http://dx.doi.org/10.1080/110241599750006569.

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Brügger, Lukas, Roman Inglin, Daniel Candinas, Tullio Sulser, and Daniel Eberli. "A novel animal model for external anal sphincter insufficiency." International Journal of Colorectal Disease 29, no. 11 (September 4, 2014): 1385–92. http://dx.doi.org/10.1007/s00384-014-2006-8.

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Park, Dong Yoon, and Joo Hyun Park. "Ultrasound‐Guided Needle Electromyography of the External Anal Sphincter." PM&R 11, no. 7 (February 8, 2019): 731–36. http://dx.doi.org/10.1002/pmrj.12012.

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