Defecation 1: Testing a hypothesis for pelvic striated muscle action to open the anorectum

Petros, Peter; Swash, Michael; Bush, Mark B.; Fernández, Manuel; Gunnemann, A.; Zimmer, M.

doi:10.1007/s10151-012-0861-2

Cited by 24 publications

(8 citation statements)

References 11 publications

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“…There is a general consensus that there is a need for greater understanding of the mechanisms that govern defecation by modeling the relative contributions of colo-recto-anal forces, motility, and motricity and the effects of structural and physiological abnormalities. This could enable identification of disease phenotypes and optimize the management of patients with disorders of defaecation [4,6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…internal rectal intussusception) or a high anorectal angle can hamper defecation [4]. Motor dysfunctions that include recto-anal dyssynergia have been shown to reduce intrarectal force / pressure and impair fecal expulsion [8,16]. However, whilst the visual assessment of the consistency of feces is well established as an aid to the diagnosis of abnormalities in bowel function [17], relatively little work has been done on the rheological properties of faeces [12,[18][19][20], which will directly influence their resistance to flow and hamper evacuation.…”

Section: Introductionmentioning

confidence: 99%

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Rheology of human faeces and pathophysiology of defaecation

Loubens

Lentle

et al. 2020

Tech Coloproctol

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Background: Rectal evacuation involves multiple mechanisms that are not completely understood. The aim of this study was to quantify the rheologic property, i.e. yield stress, that governs the ease of deformation of a range of faeces of differing consistency and understand its influence on the pathophysiology of defaecation. Methods: Yield stresses of faeces of differing consistencies and Bristol scores were determined by the Vane test. We then explored the effects of this property on ease of defecation using a simple static model of the recto-anal junction based on the laws of flow for yield stress pastes and checked the conclusions by X-ray defaecography experience. Results: The yield stress of faeces increased exponentially with their solid content, from 20 to 8000 Pa. The static model of the recto-anal junction showed that evacuation of faeces of normal consistency and yield stress is possible with moderate dilatation of the anal canal, whilst the evacuation of faeces with higher yield stress requires greater dilatation of the anal canal. X-ray defaecography showed that such increases occurred in vivo. Conclusions: The diameter of the recto-anal junction is increased to enable the passage of feces with high yield stress. The finite limits to such dilation likely contribute to fecal impaction. Hence difficulties in defaecation may result either from unduly high yield stress or pathologies of reflex recto-anal dilatation or a combination of the two.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rheology of human faeces and pathophysiology of defaecation

Loubens

Lentle

et al. 2020

Tech Coloproctol

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“…To avoid bothersome symptoms, children with urinary incontinence and JH may constantly use the pelvic floor muscles to compensate for the lack of supportive tissue, which may further lead to nonneurogenic bladder sphincter dysfunction, constipation, and faecal incontinence 33 . Petros and Swash proposed a theory focused on the musculo-elastic tissues within the pelvis and their role in anorectal dysfunction in adults 34 .The laxity of tissues may lead to the inability to generate appropriate intrarectal force during the bear-down manoeuvre. A greater prevalence of JH in adults with symptoms of rectal evacuatory dysfunction and significantly higher frequencies of morphological abnormalities in this group support this theory 23 .…”

Section: Discussionmentioning

confidence: 99%

Excessive laxity of connective tissue in constipated children

Załęski

Gawrońska

Albrecht

et al. 2022

Sci Rep

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Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested by disturbances in the functioning of internal organs, including the gastrointestinal tract. Increased susceptibility to stretching of the distal part of the large intestine and abnormal colonic motor function could explain the predisposition to the development of functional constipation in some children. Our aim was to determine whether patients with functional constipation are more likely to be characterized by congenital laxity of connective tissue compared to the population of healthy children. Children diagnosed with functional constipation according to the Rome III criteria were prospectively enrolled in the study (study group, S) and compared to otherwise healthy children (control group, C). Excessive laxity of the connective tissue was evaluated using the Beighton Score (BS) and expressed as median and interquartile range (IQR). The study included 411 patients (median age 7.8 years, min 3 years, max 18 years; 49% male), comprising 211 patients in the S group and 200 children in the C group. The median BS in the S group was significantly higher than in the C group (median: 5 points [IQR: 1–4.5] vs 2 points [IQR: 3–7], respectively; p = 0.000). Furthermore, increased connective tissue laxity was observed more frequently in females (p < 0.05). Increased connective tissue laxity was more frequent in children with functional constipation, especially in girls. Excessive laxity of the connective tissue may be one of the etiological factors of functional constipation in children.

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“…The PRM continues contracting to stiffen the anterior wall of the anorectum. External opening of the neorectum by pelvic muscles immediately prior to defecation lowers the intra-anal resistance to enable emptying ( 3 , 9 ) (see Video S5 ).…”

Section: Defecationmentioning

confidence: 99%

Structural, functional, and dysfunctional pelvic anatomy

Liedl,

Dodi,

Inoue

et al. 2024

Ann Transl Med

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The structural basis of the Integral Theory is holistic. Four main pelvic muscles interact holistically with five main pelvic ligaments to maintain pelvic organ structure and function. The vagina is structurally weak. The support it provides to the bladder base is contingent on being stretched by opposite pelvic muscle forces, much like a trampoline. Its main role is to transmit muscle forces to facilitate continence, evacuation and control of urgency. Therefore, as an organ that cannot regenerate, the vagina should be conserved, and not excised. The ligaments provide the main structural support for the organs and are the most vulnerable part of the anatomical system to injury because their structural collagen is depolymerized prior to labour, and stretched during labour. Further ligament weakening occurs after menopause due to collagen breakdown. Hence, collagen loss is the main cause of organ prolapse and lower urinary tract symptoms (LUTS). The strengthening of damaged ligaments, whether surgically or non-surgically, can improve or cure symptoms and prolapse. Because collagen loss in ligaments is a principal cause of dysfunction in older women, collagen-creating techniques are advised: precisely inserted tapes to create neoligaments, or wide-bore No. 2 or No. 3 polyester ligament sutures instead of dissolvable sutures.

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Defecation 1: Testing a hypothesis for pelvic striated muscle action to open the anorectum

Abstract: Our results are consistent with the hypothesis that pelvic striated muscle actively opens the rectal lumen, thereby reducing internal anorectal resistance to expulsion of feces. Controlled studies of electromyographic activity would be useful to further test this hypothesis.

Cited by 24 publications

References 11 publications

Rheology of human faeces and pathophysiology of defaecation

Rheology of human faeces and pathophysiology of defaecation

Excessive laxity of connective tissue in constipated children

Structural, functional, and dysfunctional pelvic anatomy

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