A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: Mass contraction of the pelvic floor muscles

The article analyzes the functional state (evacuation functions, continence) and innervation of the pelvic floor muscles in patients with rectocele and combination rectocele with internal rectal intussusception, with complaints of obstructive defecation. AIM. The study of the functional state of the pelvic floor muscles in patients with obstructive defecation syndrome (ODS). MATERIALS AND METHODS. The study included 224 women with complaints of obstructive defecation, without pelvic floor surgery. On physical examination, all patients were detected signs of rectocele. The average age - 49,9±15,0 years. 52 (23,2%) patients had complaints to the fecal incontinence of various components. Diagnostic algorithm: physical examination defecography, rectal functional study (high resolution manometry (HRAM), evacuation test, comprehensive sphincterometry, pudendal nerve study). RESULTS. Frequency of functional disorders of defecation (FDD) according to objective methods of study among patients with ODS is high and amounts to 64.7%. In this case, there are no differences in the frequency FDD in patients with a combination of rectocele and internal intussusception compared to patients with only rectocele. There were no correlation between the frequency of anal sphincter failure and FDD. We identified some patients with subclinical incontinence, without complaints but with reduced manometric values and anal sphincter contractility. We have proved the absence of correlation between the presence or absence of pelvic floor muscle innervations violations in the form of neuropathy n. pudendus and the presence or absence of FDD. CONCLUSION. FDD can cause unsatisfactory results of surgical treatment of patients with ODS, even after the restoration of the anatomic relationships due to complaints of evacuation violation. ODS diagnostic algorithm should include not only an assessment of evacuationfunction (HRAM and evacuation test), but also sphincterometry, to assess the content function.

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Examination of the descending pathway to the external anal sphincter and pelvic floor muscles by transcranial cortical stimulation

Electroencephalography and Clinical Neurophysiology ◽

10.1016/0013-4694(90)90137-9 ◽

1990 ◽

Vol 75 (6) ◽

pp. 500-510 ◽

Cited By ~ 44

Author(s):

Ç. Ertekin ◽

M.V. Hansen ◽

L.-E. Larsson ◽

R. Sjödahl

Keyword(s):

Pelvic Floor ◽

Anal Sphincter ◽

External Anal Sphincter ◽

Pelvic Floor Muscles ◽

Cortical Stimulation

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EPISIOTOMY : A CHALLENGING OBSTETRIC INTERVENTION

Journal of Nepal Medical Association ◽

10.31729/jnma.791 ◽

2003 ◽

Vol 42 (145) ◽

pp. 54-58

Author(s):

D S Malla

Keyword(s):

Blood Loss ◽

Pelvic Floor ◽

Anal Sphincter ◽

Intracranial Haemorrhage ◽

Perineal Tear ◽

Obstetric Intervention ◽

Anal Sphincter Damage

ABSTRACTThe professional literatures on the development of widely practiced procedure, episiotomy through theyears from the first publication in 1742 are reviewed. It reveals the change in number of publication as wellas the contributors to the development of perception about episiotomy. So it consisted expression of opinionof doctors initially then the co-workers like nurses and researchers and clients or consumers themselvestoo. It concludes that episiotomies prevent anterior perineal tear but fails to accomplish other benefitstraditionally ascribed to pelvic floor damage and relaxation including its sequel and also protection ofnewboin from intracranial haemorrhage and intrapartum asphyxia. Episiotomy substantially increasematernal blood loss during delivery and risk of anal sphincter damage with their long term morbidity.There is an urgent need to restrict the use of episiotomy in vaginal delivery.Key Words: Episiotomy, Perineal tear, anal sphincter damage.

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Faculty Opinions recommendation of Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8136970.8536081 ◽

2011 ◽

Author(s):

Wilfrid Jänig

Keyword(s):

Pelvic Floor ◽

Neural Control ◽

Pelvic Floor Muscles

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Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

Interface Focus ◽

10.1098/rsfs.2019.0027 ◽

2019 ◽

Vol 9 (5) ◽

pp. 20190027 ◽

Cited By ~ 1

Author(s):

Dulce Oliveira ◽

Maria Vila Pouca ◽

João Ferreira ◽

Teresa Mascarenhas

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Symphysis Pubis ◽

Pelvic Floor Muscles ◽

Point Of View ◽

Normal Vaginal Delivery ◽

Tissue Integrity ◽

Levator Trauma ◽

Reaction Forces

Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis . From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

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