scholarly journals Measuring length-tension function of the anal sphincters and puborectalis muscle using the functional luminal imaging probe

2018 ◽  
Vol 315 (5) ◽  
pp. G781-G787 ◽  
Author(s):  
Lori J. Tuttle ◽  
Ali Zifan ◽  
Catherine Sun ◽  
Jessica Swartz ◽  
Sophia Roalkvam ◽  
...  
Keyword(s):  
Anal Canal ◽  
Anal Sphincter ◽  
Puborectalis Muscle ◽  
Sphincter Muscle ◽  
Anal Sphincters ◽  
Cross Sectional ◽  
Imaging Probe ◽  
Nulliparous Women ◽  
Functional Luminal Imaging Probe ◽  
Vaginal Canal

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.

scholarly journals Loop analysis of the anal sphincter complex in fecal incontinent patients using functional luminal imaging probe

2020 ◽  
Vol 318 (1) ◽  
pp. G66-G76 ◽  
Author(s):  
Ali Zifan ◽  
Ravinder K. Mittal ◽  
David C. Kunkel ◽  
Jessica Swartz ◽  
Garrett Barr ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Anal Canal ◽  
Anal Sphincter ◽  
Normal Subjects ◽  
Sphincter Muscle ◽  
Upward Movement ◽  
Loop Analysis ◽  
Imaging Probe ◽  
Functional Luminal Imaging Probe ◽  
The Right

Cardiac loops have been used extensively to study myocardial function. With changes in cardiac pump function, loops are shifted to the right or left. Functional luminal imaging probe (FLIP) recordings allow for loop analysis of the anal sphincter and puborectalis muscle (PRM) function. The goal was to characterize anal sphincter area-pressure/tension loop changes in fecal incontinence (FI) patients. Fourteen healthy subjects and 14 patients with FI were studied. A custom-designed FLIP was placed in the vagina and then in the anal canal, and deflated in 20-ml steps, from 90 to 30 ml. At each volume, subjects performed maximal voluntary squeezes. Area-pressure (AP) and area-tension (AT) loops were generated for each squeeze cycle. Three-dimensional ultrasound imaging of the anal sphincter and PRM were obtained to determine the relationship between anal sphincter muscle damage and loop movements. With the increase in bag volume, AP loops and AT loops shifted to the right and upward in normal subjects (both anal and vaginal). The shift to the right was greater, and the upward movement was less in FI patients. The difference in the location of AP loops and AT loops was statistically significant at volumes of 50 ml to 90 ml ( P < 0.05). A similar pattern was found in the vaginal loops. There is a significant relationship between the damage to the anal sphincter and PRM, and loop location of FI patients. We propose AP and AT loops as novel ways to assess the anal sphincter and PRM function. Such loops can be generated by real-time measurement of pressure and area within the anal canal. NEW & NOTEWORTHY We describe the use of area-pressure (AP) and area-tension (AT)-loop analysis of the anal sphincters and puborectalis muscles in normal subjects and fecal incontinent patients using the functional luminal imaging probe (FLIP). There are differences in the magnitude of the displacement of the loops with increase in the FLIP bag volume between normal subjects and patients with fecal incontinence. The latter group shifts more to the right in AP and AT space.

Anal Sphincter Size Measured by Endosonography in Healthy Volunteers

1992 ◽  
Vol 33 (5) ◽  
pp. 453-456 ◽  
Author(s):  
M. B. Nielsen ◽  
C. Hauge ◽  
O. Ø. Rasmussen ◽  
M. Sørensen ◽  
J. F. Pedersen ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Anal Manometry ◽  
Internal Sphincter ◽  
External Sphincter ◽  
Muscle Thickness ◽  
Anal Endosonography ◽  
Puborectalis Muscle ◽  
Sphincter Muscle ◽  
Cross Sectional ◽  
Vaginal Deliveries

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.

scholarly journals Is an empirical approach to performing access in pediatric surgery in children safe?

2020 ◽  
pp. 43-50
Author(s):  
V.S. Konoplitskiy ◽  
◽  
R.V. Shavliuk ◽  
Keyword(s):  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Pilonidal Disease ◽  
Muscle Fibers ◽  
External Sphincter ◽  
Average Diameter ◽  
Modern World ◽  
Anal Sphincters ◽  
Cross Sectional ◽  
Surgical Interventions

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.

Pre-Clinical Applications of High-Definition Manometry System to Investigate Pelvic Floor Muscle Contribution to Continence Mechanisms in a Rabbit Model

2021 ◽  
Author(s):  
Samuel Sorkhi ◽  
Youngjin Seo ◽  
Valmik Bhargava ◽  
Mahadevan Raj Rajasekaran
Keyword(s):  
Electrical Stimulation ◽  
Anal Canal ◽  
Dynamic Pressure ◽  
Rabbit Model ◽  
Puborectalis Muscle ◽  
High Definition ◽  
System Pressure ◽  
Vaginal Canal ◽  
The Impact ◽  
Stimulation Of

External anal sphincter (EAS), external urethral sphincters and puborectalis muscle (PRM) have important roles in the genesis of anal and urethral closure pressures. In the present study, we defined the contribution of these muscles alone and in combination to the sphincter closure function using a rabbit model and a high-definition manometry (HDM) system. A total of 12 female rabbits were anesthetized and prepared to measure anal, urethral, and vaginal canal pressures using a HDM system. Pressure was recorded at rest, and during electrical stimulation of the EAS and PRM. A few rabbits (n=6) were subjected to EAS injury and the impact of EAS injury on the closure pressure profile was also evaluated. Anal, urethral, and vaginal canal pressures recorded at rest and during electrical stimulation of EAS and PRM demonstrated distinct pressure profiles. EAS stimulation induced anal canal pressure increase whereas PRM stimulation increased the pressures in all the three orifices. Electrical stimulation of EAS after injury resulted in about 19% decrease in anal canal pressure. Simultaneous electrical stimulation of EAS and PRM resulted in an insignificant increase of individual anal canal pressures when compared to pressures recorded after EAS or PRM stimulations alone. Our data confirm that HDM is a viable system to measure dynamic pressure changes within the three orifices and to define the role of each muscle in the development of closure pressures within these orifices in preclinical studies.

T1341 Sustained Improvement in Anal Canal Function Following External Anal Sphincter Muscle Plication

2010 ◽  
Vol 138 (5) ◽  
pp. S-541
Author(s):  
Mahadevan R. Rajasekaran ◽  
Yanfen Jiang ◽  
Amir Motamedi ◽  
Valmik Bhargava ◽  
Ravinder K. Mittal
Keyword(s):  
Anal Canal ◽  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Sphincter Muscle ◽  
Sustained Improvement ◽  
Anal Sphincter Muscle ◽  
External Anal Sphincter Muscle

Genesis of anal canal pressures in the opossum

1986 ◽  
Vol 251 (6) ◽  
pp. G765-G771 ◽  
Author(s):  
P. J. Culver ◽  
S. Rattan
Keyword(s):  
Anal Canal ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
External Anal Sphincter ◽  
Sphincter Pressure ◽  
Electromyographic Activity ◽  
Sphincter Muscle ◽  
Anal Sphincter Muscle ◽  
Adrenergic Antagonist ◽  
Alpha Chloralose

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.

Sign in / Sign up

Export Citation Format

Share Document