The internal anal sphincter can not close the anal canal completely

Lestár, Béla; Penninckx, Freddy; Rigauts, H; Kerremans, Raymond

doi:10.1007/bf00360358

Cited by 39 publications

(17 citation statements)

References 10 publications

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“…The bulking effect of the silicone injections may be enhancing the action of the naturally occurring anal cushions which provide closure in the gap inside the internal sphincter ring. 24 While it was expected that successful injections might cause an increase in the resting pressure, a beneficial effect on the external sphincter function was not anticipated. Squeeze pressures rose by a median of 45% (p=0.1).…”

Section: Discussionmentioning

confidence: 99%

Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction

Kenefick

Vaizey

Malouf

et al. 2002

Gut

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Background: A weak or disrupted internal anal sphincter can cause passive faecal incontinence. Conservative measures may help some patients but there is no simple surgical solution for those who fail conservative treatment. A successful technique using trans-sphincteric injection of a bulking agent to augment the internal anal sphincter was developed in a previous pilot study. Aim: To determine the clinical results and underlying physiological effects of biomaterial injection. Patients: Six patients (four males, median age 53 years (range 36-65)) with faecal incontinence to solid or liquid stool related to poor internal anal sphincter function, of varied aetiology, were recruited. Methods: Silicone based biomaterial injections were performed, under local anaesthesia, with antibiotic cover. Three injections were placed circumferentially, trans-sphincterically, entering away from the anal margin and injecting at or just above the dentate line. Anorectal physiological studies, endoanal ultrasound, a bowel symptom diary, a validated incontinence score, and quality of life questionnaires were completed before treatment and on completion of follow up. Results: At a median follow up of 18 months (range 15-19), five of six patients had marked symptom improvement. Faecal incontinence scores improved from a median of 14/24 (range 11-20) before to 8/24 (6-15) after injection. Short form-36 quality of life physical and social function scores improved from a median of 26/100 (5-33) to 79/100 (25-100) and from 10/100 (5-37) to 100/100 (50-100), respectively. There was a corresponding physiological increase in maximum anal resting and squeeze pressures. Ultrasound showed the Bioplastique to be retained in the correct position in the improved patients without migration. There were no complications. Conclusion: Trans-sphincteric injection of silicone biomaterial can provide a marked improvement in faecal incontinence related to a weak or disrupted internal anal sphincter. This is associated with improved sphincter function and quality of life.

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Section: Discussionmentioning

confidence: 99%

Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction

Kenefick

Vaizey

Malouf

et al. 2002

Gut

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“…finally, excision of the hemorrhoids may lead to reduced resting anal pressure because of loss of the anal cushions. 16,17 the manometry did not show any significant differences among the groups at any level within the anal canal. however, the isolated pressure measured at each level does not alone reflect the continence function of the anal sphincters.…”

Section: Discussionmentioning

confidence: 57%

Functional and Structural Abnormalities After Milligan Hemorrhoidectomy

Johannsson

Påhlman

Graf

2013

Diseases of the Colon &Amp; Rectum

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“…Other factors that play a role in maintaining fecal continence include structural properties of the anorectum such as the capacity of the fecal reservoir [7,8], the anorectal angle [9] and the integrity of the ‘anal mucosal seal’ [10,11]. Effective rectal function must also be preserved including the accommodation of stool and timely, appropriate sensitivity during rectal filling [6,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Fecal Continence in Healthy, Continent Subjects: A Comprehensive Analysis by Anal Manometry, Rectal Barostat and a Stool Substitute Retention Test

et al. 2010

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Background/Aims: This study aimed to identify anal sphincter and rectal factors that determine anorectal filling sensations and continence during rectal filling in health. Methods: Measurements of anorectal physiology were collected from 42 continent healthy subjects participating in a prospective trial. Rectal function and capacity were assessed by barostat. Anal sphincter functions were assessed by manometry. A validated stool substitute retention test was performed in which a viscous suspension was infused into the rectum at 60 ml/min to 1,500 ml. Multivariate regression was applied to identify physiologic factors that determine anorectal sensation and continence during rectal filling. Results: The volume at which first awareness of rectal filling occurred associated with age (p < 0.03), rectal capacity (p < 0.06) and anal resting pressure (p < 0.003); urgency associated with rectal capacity (p < 0.0007), anal resting (p < 0.04) and squeeze pressure (p < 0.02); volume at first incontinence with rectal capacity (p < 0.0001) and squeeze pressure (p < 0.04) and the maximum volume retained were closely correlated with rectal capacity only (p < 0.0001). Conclusion: Anorectal filling sensations and continence in health require a rectal reservoir of adequate capacity and effective voluntary anal sphincter function. Complementary associations between continence, motor and sensory function indicate the presence of an adaptive mechanism that enables timely, appropriate responses to events that threaten fecal continence.

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The internal anal sphincter can not close the anal canal completely

Cited by 39 publications

References 10 publications

Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction

Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction

Functional and Structural Abnormalities After Milligan Hemorrhoidectomy

Determinants of Fecal Continence in Healthy, Continent Subjects: A Comprehensive Analysis by Anal Manometry, Rectal Barostat and a Stool Substitute Retention Test

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