Biopsies of the external anal sphincter, puborectalis, and levator ani muscles have been examined in 24 women and one man with long-standing anorectal incontinence, 18 of whom also had rectal prolapse, and in two men with rectal prolapse alone. In 16 of the women anorectal incontinence was of unknown cause, but in eight there was a history of difficult labour. Similar biopsies were examined in ...

PURPOSE Few studies have examined whether bioengineering can improve fecal incontinence. This study designed to determine whether injection of porous polycaprolactone beads containing autologous myoblasts improves sphincter function in a dog model of fecal incontinence. METHODS The anal sphincter of dogs was injured and the dogs were observed without and with (n = 5) the injection of porous p...

Lateral sphincterotomy diminishes internal anal sphincter hypertonia and thereby reduces anal canal pressure. This improves anal mucosal blood flow and promotes the healing of anal fissures. However, sphincterotomy can be associated with long term disturbances of sphincter function. The optimal treatment for an anal fissure is to induce a temporary reduction of anal canal resting pressure to al...

The effects of serotonin (5-hydroxytryptamine, 5-HT) on the internal anal sphincter were studied in anaesthesized rats. Serotonin induced a dose dependent relaxation of the internal anal sphincter. Methysergide blocked this relaxation, but did not affect the rectoanal reflex. Methysergide did not antagonise the actions of cholinergic and adrenergic agonists on the internal anal sphincter. Other...

Background—Topical nitrates lower anal sphincter pressure and heal anal fissures, but a majority of patients experience headache. The internal anal sphincter has a calcium dependent mechanism to maintain tone, and also receives an inhibitory extrinsic cholinergic innervation. It may therefore be possible to lower anal sphincter pressure using calcium channel blockers and cholinergic agonists wi...

BACKGROUND Topical nitrates lower anal sphincter pressure and heal anal fissures, but a majority of patients experience headache. The internal anal sphincter has a calcium dependent mechanism to maintain tone, and also receives an inhibitory extrinsic cholinergic innervation. It may therefore be possible to lower anal sphincter pressure using calcium channel blockers and cholinergic agonists wi...

PURPOSE: To evaluate the prevalence of anal incontinence (AI) in primiparous women five years after their first delivery; to investigate if an 8-12 hour time delay of primary repair affects AI at 1-year follow-up; to study the association between endoanal ultrasonography and anorectal manometry in relation to AI in primiparous women; to evaluate whether an endoanal ultrasonographic derived sphi...

A 28-year-old primigravida undergoes a forceps delivery with a midline episiotomy for failure to progress in the second stage of labor. At birth, the infant weighs 4 kg (8.8 lb), and the episiotomy extends to the anal verge. The resident who delivered the child is uncertain whether the anal sphincter is involved in the injury and asks a consultant to examine the perineum. What should this exami...

Background Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from ...