Internal anal sphincter

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Topic: Internal anal sphincter

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	American Family Physician: Primary Repair of Obstetric Anal Sphincter Lacerations
		At the four-month postpartum visit, women with a history of obstetric laceration were noted to have significantly more separated anal sphincters and decreased resting and squeeze tones on physical examination, a disrupted internal anal sphincter on ultrasonography and increased fecal incontinence scores with respect to the control group.
		Overall, the fecal incontinence score was associated with a disrupted internal anal sphincter but not with disruption of the external anal sphincter, as determined by ultrasonography.
		At the same visit, ultrasonography of women with a laceration history and of control subjects revealed a disrupted external anal sphincter in 40 and 20 percent, respectively, and a disrupted internal anal sphincter in 47 and 7 percent, respectively.
	www.findarticles.com /p/articles/mi_m3225/is_11_61/ai_62829285 (810 words)

	eMedicine - Anal Fissure : Article by Lisa S Poritz, MD
		The fibers of the internal anal sphincter are visible in the base of the chronic fissure, and often, an enlarged anal skin tag is present distal to the fissure and hypertrophied anal papillae are present in the anal canal proximal to the fissure.
		The internal anal sphincter is a smooth muscle that is the most distal extension of the inner circular smooth muscle of the colon and the rectum.
		In patients with hypertrophied internal anal sphincters, this delicate blood supply is further compromised, thus rendering the posterior midline of the anal canal relatively ischemic.
	www.emedicine.com /med/topic3532.htm (3552 words)

	Measurement of Anal Sphincter Muscles: Endoanal US, Endoanal MR Imaging, or Phased-Array MR Imaging? A Study with Healthy Volunteers -- Beets-Tan et al. 220 (1): 81 -- Radiology
		Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence.
		Transverse T2-weighted turbo spin-echo endoanal MR image (3,427/150) of the anal sphincter complex obtained at the midanal level in the same volunteer as in Figure 1 shows the internal sphincter muscle as a homogeneous hyperintense circular band surrounding the anal canal.
		Anatomic and physiologic measurements of the internal and external anal sphincters in normal females.
	radiology.rsnajnls.org /cgi/content/full/220/1/81 (5666 words)

	OB/GYN News: Anal incontinence & sphincter injury: vaginal childbirth a factor
		Ultrasound identified anal sphincter defects in the external anal sphincter (61% of women), internal anal sphincter (3%), or both (36%).
		Anal sphincter injury was significantly more likely to be found in women with stage IV prolapse than in those with stage I prolapse.
		HOLLYWOOD, FLA. -- Anatomic anal sphincter injury from vaginal childbirth is significantly associated with anal incontinence and stage IV pelvic organ prolapse, according to a study presented at the annual meeting of the American Urogynecologic Association.
	www.findarticles.com /p/articles/mi_m0CYD/is_21_38/ai_110804568 (528 words)

	anatomical sphincter - Hutchinson encyclopedia article about anatomical sphincter
		The external anal sphincter closes the anus&; the internal anal sphincter constricts the rectum&; the sphincter vesicae controls the urethral orifice of the bladder.
		Ring of muscle, such as is found at various points in the alimentary canal, that contracts and relaxes to open and close the canal and control the movement of food.
		The pyloric sphincter, at the base of the stomach, controls the release of the gastric contents into the duodenum.
	encyclopedia.farlex.com /anatomical+sphincter (157 words)

	Anal fissure
		This is called an internal sphincterotomy, a procedure in which the anal sphincter is partially cut, thus allowing it to relax and permitting the fissure to heal.
		Anal fissures are tears in the skin overlying the anal sphincter, usually due to increased tone of the anal sphincter muscles, and a failure of these muscle to relax.
		Sphincterotomy, when properly performed, is very effective in healing anal fissures.
	www.shands.org /health/surgeries/100154.html (514 words)

	Neuromyogenic properties of the internal anal sphincter: therapeutic rationale for anal fissures -- BHARDWAJ et al. 46 (6): 861 -- Gut
		The internal anal sphincter response: manometric studies on its normal physiology, neural pathways, and alteration in bowel disorders.
		The response of the internal anal sphincter in man to stimulation of the presacral nerve.
		Pharmacological study of the internal anal sphincter in patients with chronic anal fissure.
	gut.bmjjournals.com /cgi/content/full/46/6/861 (5949 words)

	Treating the Anal Sphincter
		There is evidence that hemorrhoid sufferers have increased tightness of the anal sphincter, and some studies are showing that a variety of anal sphincter-relaxing remedies may promote improvement in prolapsed internal hemorrhoids and thrombosed external hemorrhoids, possibly avoiding surgery, or make it possible to to use techniques short of scalpel hemorrhoidectomy.
		ANAL FISSURES have been found to be associated with increased anal sphincter muscle tone, and the research demonstrating fissure healing with calcium channel blockers and other agents may be applicable to external hemorrhoids......
		Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects.
	www.geocities.com /md_duba/GP32.html (1325 words)

	UpToDate Surgical management of the disrupted anal sphincter
		Reconstructive surgery should aim at restoring the continuity of both the external and internal anal sphincter.
		Anal sphincter injury is often occult and can lead to fecal incontinence many years after delivery [2,3].
		The anatomy and physiology of the anal sphincter, pathogenesis of anal sphincter dysfunction, and evaluation of patients with fecal incontinence is discussed separately.
	patients.uptodate.com /topic.asp?file=gyn_surg/12839 (388 words)

	Anatomical reminder about anal sphincter
		The internal anal sphincter is composed by smooth muscular fiber and provided with a reflex type comportment.
		The external anal shincter is composed by ridge muscular fiber and is moved by a volunter action.
		This muscular set is located in the anal channel, between the anus and the rectum.
	www.esiee.fr /~rocarief/artmbfr1/node3.html (107 words)

	Limbs & Things - Sultan Anal Sphincter Trainer
		For practising the techniques associated with the repair of the internal and external sphincter (3rd degree tear).
		The Anal Sphincter Block presents the following realistic anatomy:
		This model was developed in collaboration with Mr Abdul Sultan, Mayday Hospital, Croydon, UK.
	www.limbsandthings.com /usa/products.php?partno=60227 (98 words)

	Fortnightly review : Faecal incontinence -- Kamm 316 (7130): 528 -- BMJ
		of the internal anal sphincter is the commonest cause of soiling.
		The ultrasound probe is central; the dark ring is the internal anal sphincter and the white structure surrounding it is the external anal sphincter muscle (arrows indicate outer limits).
		lower internal anal sphincter in chronic anal fissure.
	bmj.bmjjournals.com /cgi/content/full/316/7130/528 (2577 words)

	Glazer/Romanzi/Polaneczky
		It consists of the internal anal sphincter, a thickening of the smooth muscle extending down from the distal portion of the rectum, which is maximally contracted during storage, and the external anal sphincter, consisting of bundles of striated muscle fiber, including the deep, superficial and subcutaneous bundles.
		The anal canal is surrounded by the voluntary external anal sphincter and the involuntary internal anal sphincter.
		external anal sphincter or puborectalis) often referred to as sphincter dyssenergia in the external anal sphincter or paradoxical or nonrelaxing puborectalis in the puborectalis muscle.
	www.vulvodynia.com /dia_vv_ab6.htm (2577 words)

	Chapter 11 - Section 4: First Principles of Gastroenterology
		The important principles of all excisional procedures are removal of all external and internal hemorrhoids, protection of the internal anal sphincter from injury, and maintenance of the anoderm, so as to avoid anal stenosis.
		Internal hemorrhoids are the symptomatic, enlarged submucosal vascular cushions of the anal canal.
		Motor innervation of the external anal sphincter is via the inferior rectal branch of the pudendal nerve and the perineal branch of the fourth sacral nerve.
	www.gastroresource.com /GITextbook/En/Chapter11/11-4.htm (2577 words)

	Glazer/Romanzi/Polaneczky
		It consists of the internal anal sphincter, a thickening of the smooth muscle extending down from the distal portion of the rectum, which is maximally contracted during storage, and the external anal sphincter, consisting of bundles of striated muscle fiber, including the deep, superficial and subcutaneous bundles.
		However it has been demonstrated that this response does not occur if the individual does not sense rectal distension even when the distension produces internal anal sphincter relaxation, showing this to be a learned response (Whitehead, Orr, Engel and Schuster, 1981).
		Second, a weak external anal sphincter, often resulting from prolonged second stage labor, surgery, radiation or rectal tearing during childbirth can lead to fecal incontinence because the descending stool pressure cannot be offset by the pressure of the external anal sphincter.
	www.vulvodynia.com /dia_vv_ab6.htm (2577 words)

	Case 13-Diarrhea
		Defecation occurs as a reflux to distention pressures of the rectum with relaxation of the internal and external anal sphincters.
		The internal anal sphincter is made of smooth muscle and is relaxed via parasympathetic innervation with the pudendal nerve.
		There is also a parasympathetic defecation reflex, where parasympathetic signals are sent to the sacral segments via the pelvic nerve and then back to the colon reflexly to greatly intensify peristaltic waves and relax the internal anal sphincter.
	socrates.berkeley.edu /~alanburr/physiol/webcc99/ccGI.01htm.htm (2577 words)

	eMedicine - Anal Fissure : Article by Lisa S Poritz, MD
		The fibers of the internal anal sphincter are visible in the base of the chronic fissure, and often, an enlarged anal skin tag is present distal to the fissure and hypertrophied anal papillae are present in the anal canal proximal to the fissure.
		Studies of the internal anal sphincter and of anal canal physiology have been performed with varied results, but at least one abnormality is likely present in the internal anal sphincter of many anal fissure patients.
		Problem: An anal fissure is a painful linear tear or crack in the distal anal canal, which, in the short-term, usually involves only the epithelium and, in the long-term, involves the full thickness of the anal mucosa (see Images 1-2).
	www.emedicine.com /med/topic3532.htm (3552 words)

	eMedicine - Rectal Prolapse : Article by Lisa S Poritz, MD
		Internal anal sphincter: The internal anal sphincter is a smooth muscle that is the most distal extension of the inner circular smooth muscle of the colon and the rectum.
		External anal sphincter: The external anal sphincter is striated muscle that forms a circular tube around the anal canal.
		In an anterior resection for rectal prolapse, the rectum is mobilized to the level of the lateral ligaments, and the redundant colon (sigmoid) is resected.
	www.emedicine.com /med/topic3533.htm (3552 words)

	eMJA: Faecal incontinence: common and treatable
		Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence.
		In a specialist centre, the commonest cause of faecal incontinence is structural anal sphincter damage associated with childbirth.
		Topical pharmacological therapies have radically altered the management of anal fissure, thereby preventing the need for surgical sphincterotomy (one of the causes of incontinence).
	www.mja.com.au /public/issues/176_02_210102/kam10579_fm.html (1421 words)

	Cellegy: Science & Innovation
		Nitroglycerin is known to relax the internal anal sphincter, and smooth muscle in general, by acting as a nitric oxide donor.
		Notably, the internal anal sphincter (IAS) of patients with hemorrhoids demonstrates an abnormal rhythm of contraction and also exerts a greater force of contraction than in individuals without hemorrhoids.
		However, an overactive sphincter might contribute to venous congestion, expose the anal cushions to greater shear forces, or do both by constricting the anal canal.
	www.cellegy.com /science/hemorrhoids.html (1421 words)

	bowel incontinence and sphincter New resources for bowel incontinence and sphincter
		Salt tablets are the internal sphincter at the degree and bilateral...
		RCTs, or Milk of the internal sphincter at the rehabilitation...
		Injury to the anal sphincter muscles can lead to incontinence of bowel contents and the need to...
	www.1st-incontinence.info /bowelincontinenceandsphincter (1421 words)

	PTP Implants for the treatment of Fecal Incontinece
		An alternative approach would be to directly fill the asymmetric anal canal defect using PTQ Implants, a bulking agent, to augment the internal sphincter muscle.
		"The Internal Anal Sphincter (IAS) provides most of the resting anal pressure, and is the main muscle responsible for the prevention of anal leakage.
		These would be appropriate in cases of major sphincter disruption, but require considerable expertise to achieve a good result and are associated with a relatively high complication rate.
	www.uroplasty.com /PTPS.asp (234 words)

	ANAL FISSURE INFORMATION PAGE
		The anal fissure is expected to heal now that the internal anal sphincter muscle is more relaxed and the fissure is cleaned up.
		He said that he would cut into the internal anal sphincter muscle to relax it.
		I saw a Digestive Health specialist, who diagnosed "Anal Fissure" although he was unable to do a rectal exam because my anal sphincter muscles spasmed upon touch.
	www.paxcredo.net /surgical.html (1984 words)

	Ten Rules of Anal Sex
		The internal sphincter reflects and responds to fear and anxiety during anal sex.
		Even if a person does feel comfortable during anal sex, he or she may still need to learn voluntary control over his or her internal sphincter in order to relax it at will.
		The taboo against anal eroticism is perpetuated by the almost universal belief among physicians that anal sex is inevitably dangerous.
	www.sexuality.org /authors/morin/analrule.html (2016 words)

	Gastroenterology Chapter 11 The Anal Canal
		The wall of the anal canal is formed by a continuation of the circular muscle of the rectal wall; the smooth muscle is thickened in this area to form the internal anal sphincter.
		Motor innervation of the external anal sphincter is via the inferior rectal branch of the pudendal nerve and the perineal branch of the fourth sacral nerve.
		Anal pain of any etiology may be aggravated by bowel movements.
	gastroresource.com /GITextbook/en/chapter11/11-4-pr.htm (2016 words)

	Emergency Medicine
		Typically, the internal anal sphincter becomes spastic, an important observation with regard to current thoughts on the pathogenesis of anal fissure and one with great implications for treatment of this condition.
		The inner aspects of the internal and external anal sphincters and the intersphincteric groove may be palpated.
		Because ischemia or poor perfusion of the posterior midline aspect of the anal sphincter may be a contributing factor in the failure of anal fissures to heal, topical vasodilators have been used as treatment options.
	www.emedmag.com /html/pre/fea/features/011504.asp (2016 words)

	Literatur
		Chronic elevation of the internal anal sphincter tone may also obstruct the outflow from the internal rectal plexus.
		In Longo´s view, reduction of the prolapse restores the topographic relations between the anal mucosa and the anal sphincter, thus improving venous drainage and minimizing complications.
		Prolapse of hemorrhoids, rectal and anal mucosa is known to be very common in humans beyond the age of 50 years, but only causes symptoms in a minority of cases.
	www.eurochirurgie.com /html/literatur.html (2016 words)

	Anal Fissure Self Help Page
		Chronic anal fissure used to be treated by dividing the internal sphincter.
		Wannas was able to prove the cause and the persistence of the chronic anal fissure is not internal sphincter spasm, and thus, there is no need for its division.
		Patient 54 This fellow had his fissure heal and then went on to have a sphincterotomy that stop the intense pain that was being caused by pressure and tightness of the rectal muscles.
	www.boardsailor.com /jack/af (5485 words)

	Restorative proctocolectomy
		As the pouch is guided down, each suture is passed through the mucosa of the anal canal picking up a part of the internal sphincter at the level of the mucosectomy.
		These sutures are placed individually by ‘backhanding’ the needle, picking up the mucosa and internal sphincter and then the pouch from out to in.
		This ideal approach is not practical when the patient requires a pouch in the semi-urgent situation but in all cases the patient must be aware that the operation is a complex procedure, that the end result is unpredictable and that there is a risk of certain complications.
	www.rcsed.ac.uk /journal/vol46%5F1/4610004.htm (4627 words)

	Hemorrhoid.net - Anatomy - Anus and Rectum
		This muscle is surrounded by the superficialis portion of the external sphincter and forms the en tire inner muscular layer of the wall of the anal canal (Fig.
		The upper and inner margin is separated from the lower edges of the internal sphincter by prominent insertions of the fibroelastic extensions of the conjoined longitudinal muscle.
		The terminal portion of the circular muscle coat of the rectum gradually thickens to become the component of the internal sphincter.
	www.hemorrhoid.net /anatomy.php (4627 words)

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In the News (Sun 3 Jun 12)