Anal sphincter

Anal sphincter. Muscle located in the terminal part of the digestive tract. Controls the expulsion of fecal matter from the body.

 

Summary

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  • 1 Types of sphincters
  • 2 Defecation mechanism
  • 3 Methods of repair for obstetric anal sphincter injuries
  • 4 Diet
  • 5 Kegel exercises
  • 6 Biofeedback
  • 7 Sources

Types of sphincters

At this level there are two sphincters:

  • Internal sphincter:Whose function is automatic and is made up of smooth muscle fibers. The external sphincter muscle of the anus ([TA]: musculus sphincter ani externus) is a muscle that is located in the lower part of the rectum in the posterior perineum . It has the shape of a flattened ring. It is inserted from behind in the anococcígeo raphe ; or ahead in the Anobulbar area . It is supplied by the hemorrhoidal nerve . It fulfills the function of being a constrictor of the anus .
  • External sphincter:Under the control of the will. The internal sphincter muscle of the anus ([TA]: musculus sphincter ani internus), or internal anal sphincter, is located on the inside of the rectum , which is a continuation of its inner circular muscle layer.

It is a muscular ring that is inserted between the rectal canal and the external anal sphincter, which wraps its muscle fibers from the bottom where they are in contact, although anatomically it is very different from it. It has a thickness of approximately 5 mm and a length of 25 to 30 mm, and is formed by an aggregation of the involuntary circular fibers of the large intestine. Its lower edge is connected to the skin of the anus hole, which is located approximately 6 mm. The internal sphincter muscle is smooth; the external, in opposition, is made up of striated muscle.

Like a valve, it fulfills the function of supporting the external anal sphincter in the excretion of feces; In addition, it helps to occlude the anal opening to prevent the entry of objects that could damage the intestinal walls, as well as stopping the passage of gases and feces in a liquid state. Its action is totally involuntary, that is, it is not controlled by human consciousness. Its contraction and relaxation takes place spontaneously. The normal condition of the internal sphincter is contracted. The relaxation reflex is caused by the pressure of stool from the rectum during defecation.The parasympathetic fibers of the pelvic segments of the spinal cordsupply the internal sphincter. It is not innervated by the pudendal nerve, which carries somatic (motor and sensory) fibers to the fibers that provide the innervation of the external anal sphincter.

Defecation Mechanism

The mechanism of defecation is as follows: the presence of stool in the rectal ampoule makes the sensation of need felt and the internal anal sphincter is relaxed. Immediately afterward, the external anal sphincter reflexively contracts. The patient can continue to contract the sphincter while waiting to go to the bathroom, and defecation begins when the patient decides to release it. In the event of abnormality of these sphincters, these mechanisms are not possible and involuntary loss of stool may occur: it is referred to as fecal or rectal incontinence .

Repair methods for obstetric anal sphincter injuries

Primary anal sphincter repair with approximation and overlap repair techniques appears to be associated with a lower risk of fecal urgency, a lower incontinence score, and deterioration of anal continence. Appropriate size clinical trials are needed to assess the efficacy and safety of the two techniques when used at different levels of healthcare.

An anal sphincter re-education, Kegel exercise, or biofeedback therapy program can be used by people to help improve their bowel movements. Conditions that may help are:

  • Fecal incontinence.
  • Neurological problems (such as from multiple sclerosis or other conditions).
  • Severe constipation

The bowel control program includes several steps to help you defecate regularly. After a few weeks, most people can have regular bowel movements. Some people will need to use laxatives in conjunction with anal sphincter reeducation. Your doctor can tell you if you need to take these medicines and which ones are safe for you.

A physical examination will be necessary before starting an anal sphincter education program. This will allow the doctor to find the cause of the fecal incontinence. At that time, disorders that can be corrected, such as fecal impaction or infectious diarrhea , can be treated . The physician will use the patient’s defecation history and lifestyle as a guide in establishing new patterns for defecation.

Diet

Making the following diet changes will help you have bulky, smooth, regular stools.

  • Eat fiber-rich foods like whole wheat grains , fresh vegetables , and legumes .
  • Use products containing psyllium, such as Metamucil , to add bulk to the stools.
  • Try to drink two to three liters of fluid a day, unless you have a condition that requires restricting your intake, such as heart or kidney disease.

Kegel exercises

Exercises to strengthen rectal muscles can help with intestinal control in people who have anal sphincter incompetence. Kegel exercises that strengthen the tone of the rectum and pelvic muscles can be used for this. These exercises were originally developed to control incontinence in women after childbirth.

Biofeedback

Biofeedback provides auditory or visual feedback on body function. In people with fecal incontinence, biofeedback is used to strengthen the anal sphincter. A rectal plug is used to detect the strength of the rectal muscles. A monitoring electrode is placed on the abdomen. The rectal plug is then connected to a computer monitor that displays a graph on the screen that shows rectal muscle contractions and abdominal contractions. To use this method, you will be taught how to contract the rectum muscle around the rectal plug. The graphic displayed on the computer serves as a guide to verify that you are doing it correctly. Your symptoms should start to improve after three sessions.

 

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