scholarly journals The Physiology, Pharmacology and Therapeutic Manipulation of the Internal Anal Sphincter

2002 ◽  
Vol 16 (4) ◽  
pp. 249-257 ◽  
Author(s):  
Oliver M Jones ◽  
Alison F Brading ◽  
Neil J McC Mortensen
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Internal Sphincter ◽  
High Rate ◽  
Pharmacological Manipulation ◽  
Routes Of Administration ◽  
Sphincter Tone ◽  
Health And Disease ◽  
Medical Approach

Recent research into the physiology and pharmacology of the internal anal sphincter has elucidated the importance of this structure in health and disease. Its pharmacological manipulation for therapeutic gain has focused mainly on agents to reduce internal anal sphincter tone, a ‘chemical sphincterotomy’ that might heal chronic anal fissure. However, drugs to increase sphincter tone, and augment intermittent and appropriate relaxation are also being evaluated. The initial results with this medical approach to anorectal disease have often been disappointing, failing to match the results achievable with surgery, and many of these drugs have a high rate of side effects in the short term. However, clinical trials have yet to establish the optimum doses, dose intervals and routes of administration for many of these therapies. Furthermore, it is uncertain whether this medical approach should be applied to all patients or just to an as yet undefined subgroup. Certainly, even in the current environment of uncertainty, there is little reason not to try medical manipulation of the internal sphincter as first-line treatment. Surgery remains an option for treatment failures; patients responding to pharmacological manipulation of the internal anal sphincter are spared the long term risks of continence that are inherent in many surgical procedures on the anorectum.

scholarly journals Long-term outcome of sphincteroplasty with separate suturing of the internal and the external anal sphincter

2019 ◽  
Vol 23 (12) ◽  
pp. 1163-1172 ◽  
Author(s):  
M. R. Berg ◽  
H. Gregussen ◽  
Y. Sahlin
Keyword(s):  
Anal Sphincter ◽  
Anal Incontinence ◽  
Internal Anal Sphincter ◽  
External Anal Sphincter ◽  
Internal Sphincter ◽  
Long Term Outcome ◽  
Obstetric Injury ◽  
Endoanal Sonography

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.

Distribution of Interstitial Cells of Cajal in the Internal Anal Sphincter of Patients With Internal Anal Sphincter Achalasia and Hirschsprung Disease

2003 ◽  
Vol 127 (9) ◽  
pp. 1192-1195 ◽  
Author(s):  
Anna Piaseczna Piotrowska ◽  
Valeria Solari ◽  
Prem Puri
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Interstitial Cells Of Cajal ◽  
Internal Sphincter ◽  
Smooth Muscles ◽  
Hirschsprung Disease ◽  
Interstitial Cells ◽  
Nerve Fibers ◽  
Internal Anal Sphincter Achalasia ◽  
Cells Of Cajal

Abstract Context.—Interstitial cells of Cajal (ICCs) are pacemaker cells in the smooth muscles of the gut. The internal anal sphincter (IAS) is the most caudal part of gastrointestinal tract. It has the important function of maintaining fecal continence. It has been proposed that ICCs in the IAS mediate the inhibitory innervation of the recto-anal reflexes. Objective.—To investigate the distribution of ICCs in the normal IAS and in the IAS of children diagnosed with internal anal sphincter achalasia (IASA) and Hirschsprung disease (HD). Methods.—At the time of IAS myectomy, specimens of the IAS were taken from 8 patients with IASA, 4 patients with HD, and 4 normal controls. All specimens were examined using anti–c-Kit and antiperipherin antibodies; immunolocalization was detected with light microscopy. Density of the ICCs was graded by computerized image analysis. Results.—There was strong peripherin immunoreactivity in the ganglia cells and nerve fibers in the normal IAS. The number of peripherin-positive nerve fibers was markedly reduced in the IAS in patients with IASA. In HD patients, there was lack of peripherin immunoreactivity in the IAS, but hypertrophic nerve trunks stained strongly. Many c-Kit–positive ICCs were present among the muscle fibers and between the muscle bundles in the normal IAS. In HD and IASA patients, ICCs were absent or markedly reduced. Conclusion.—Altered distribution of ICCs in the internal sphincter in IASA and HD may contribute to motility dysfunction in these patients.

Use of Smooth Muscle Plasty After Intersphincteric Rectal Resection to Replace a Partially Resected Internal Anal Sphincter: Long-Term Follow-Up

2009 ◽  
Vol 52 (11) ◽  
pp. 1895-1901 ◽  
Author(s):  
Osman Krand ◽  
Tunç Yalti ◽  
Gurkan Tellioglu ◽  
Melih Kara ◽  
Ibrahim Berber ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Rectal Resection ◽  
Long Term Follow Up

scholarly journals Fishing for (in)continence: long-term follow-up of women with OASIS–still a taboo

2020 ◽  
Author(s):  
Sabine Schütze ◽  
Benedikt Hohlfeld ◽  
Thomas W. P. Friedl ◽  
Stephanie Otto ◽  
Katrina Kraft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Floor ◽  
Anal Sphincter ◽  
Negative Impact ◽  
Urinary Stress Incontinence ◽  
University Hospital ◽  
High Rate ◽  
Cough Test

Abstract Purpose Obstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life. Material and methods Between 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction. Results A high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire. Conclusion On one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems.

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