International Journal of Colorectal Disease

, Volume 4, Issue 2, pp 118–122

The composition of anal basal pressure

An in vivo and in vitro study in man
  • B. Lestar
  • F. Penninckx
  • R. Kerremans
Original Articles

Abstract

The maximal anal basal pressure (MABP) was measured with probes of 0.3, 1, 2 and 3 cm diameter in 21 subjects, 60 years old, without anal pathology. The components of MABP were analyzed by inducing a maximal internal sphincter (IS) relaxation, taking pressure measurements in the conscious state and during narcosis with curarization. In seven cases pressure measurements were done on isolated anorectum after abdominoperineal rectum amputation. MABP increases with probe diameter before as well as during anaesthesia with curarization. The contribution of the striated sphincter tonic activity is constant within the range of probe diameters used. At rest, i.e. when the 0. 3 cm diameter pressure recording probe is used, 30% of MABP is made up by striated sphincter tonic activity, 45% of it is due to nerve induced IS activity, 10% to purely myogenic IS activity and 15% can be attributed to the expansion of the haemorrhoidal plexuses. Although MABP is mainly based on active forces generated by the smooth and striated sphincter apparatus, the presence of the anal cushions is essential for perfect anal continence, as they have to fill the gap within the IS ring to hermetically close the anal canal. The global IS activity, contributing 50–60% of MABP at rest, can completely be inhibited by a maximal rectoanal inhibitory reflex. Stretching of passive elements starts at 1 cm anal distension, but steeply increases thereafter, accounting for 65% of the MABP at 3 cm anal distension. It is deduced that optimal stool diameter is about 2 cm.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kerremans R (1969) Morphological and physiological aspects of anal continence and defaecation. Editions Arscia SA, Brussels, p 263Google Scholar
  2. 2.
    Duthie H (1971) Anal continence. Gut 12:844–852Google Scholar
  3. 3.
    Kuypers J (1984) Faecal incontinence and the anorectal angle. Neth J Surg 36:20–23Google Scholar
  4. 4.
    Read N, Bartolo D, Read M (1984) Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 71:39–42Google Scholar
  5. 5.
    Bennett R, Duthie H (1964) The functional importance of the internal anal sphincter. Br J Surg 51:355–357Google Scholar
  6. 6.
    Floyd W, Walls E (1953) Electromyography of the sphincter ani externus in man. J Physiol 122: 599–609Google Scholar
  7. 7.
    Schuster M (1975) The riddle of the sphincters. Gastroenterology 69:249–262Google Scholar
  8. 8.
    Shepherd J (1972) The nerve supply of the internal anal sphincter. Aust NZ J Surg 42:50–52Google Scholar
  9. 9.
    Burleigh D, D'Mello A (1983) Neural and pharmacologic factors affecting motility of the internal anal sphincter. Gastroenterology 84:409–417Google Scholar
  10. 10.
    Frenckner B, Ihre T (1976) Influence of autonomic nerves on the internal sphincter in man. Gut 17:306–312Google Scholar
  11. 11.
    Frenckner B, von Euler C (1975) Influence of pudendal block on the function of the anal sphincters. Gut 16:482–489Google Scholar
  12. 12.
    Gibbons C, Trowbridge E, Bannister J, Read N (1986) Role of anal cushions in maintaining continence. Lancet 1:886–887Google Scholar
  13. 13.
    Gibbons C, Bannister J, Trowbridge E, Read N (1986) An analysis of anal sphincter pressure and anal compliance in normal subjects. Int J Colored Dis 1:231–237Google Scholar
  14. 14.
    Duthie H, Watts J (1965) Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 6:64–68Google Scholar
  15. 15.
    Schweiger M (1979) Method for determining individual contributions of voluntary and involuntary anal sphincters to resting tone. Dis Colon Rectum 22:415–416Google Scholar
  16. 16.
    Duthie H, Kwong N, Brown B (1970) Adaptability of the anal canal to distension (Abstract). Br J Surg 57:388Google Scholar
  17. 17.
    Wheatley I, Hardy K, Dent J (1977) Anal pressure studies in spinal patients. Gut 18:488–490Google Scholar
  18. 18.
    Meunier P, Mollard P (1977) Control of the internal anal sphincter. Manometric study with human subjects. Pflügers Arch 370:233–239Google Scholar
  19. 19.
    Baumgarten H (1967) Über die Verteilung von Catecholaminen im Darm des Menschen. Z Zellforsch 83:133–137Google Scholar
  20. 20.
    Baumgarten H, Holstein A, Stelzner F (1971) Differences in the innervation of the large intestine and internal anal sphincter in mammals and humans. Verhandlungen der Anatomischen Gesellschaft 66:43–47Google Scholar
  21. 21.
    Gutierrez J, Shah A (1975) Autonomic control of the internal anal sphincter in man. In: Vantrappen G (ed) 5th International Symposium of Gastrointestinal Motility (Belgium). Typoff Press, pp 363–373Google Scholar
  22. 22.
    Schiller L, Santa Ana C, Schmulen A, Hendler R, Harford W, Fordtran J (1982) Pathogenesis of faecal incontinence in diabetes mellitus. N Engl J Med 307:1666–1671Google Scholar
  23. 23.
    Neil M, Parks A, Swash M (1981) Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse. Br J Surg 68:531–536Google Scholar
  24. 24.
    Matheson D, Keighley M (1981) Manometric evaluation of rectal prolapse and faecal incontinence. Gut 22:126–129Google Scholar
  25. 25.
    Cortesini C, Pucciani F, Carassale G, Paparozzi C (1983) Anorectal physiology after anterior resection and pullthrough operation. Eur Surg Res 15:176–183Google Scholar
  26. 26.
    Jostarndt L, Thiede A, Lau G, Hamelmann H (1984) Die anorectale Kontinenz nach manueller und maschineller Anastomosennaht. Chirurg 55:385–390Google Scholar
  27. 27.
    Bartram C (1988) In: Finlay I. Symposium on proctography. Int J colored Dis 3:67–89Google Scholar
  28. 28.
    Womack N (1988) Symposium on proctography (Moderator: Finlay IG). Int J Colored Dis 3:67–89Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • B. Lestar
    • 1
  • F. Penninckx
    • 1
  • R. Kerremans
    • 1
  1. 1.Department of Gastroenterological Surgery, University Clinic GasthuisbergCatholic University of LeuvenBelgium

Personalised recommendations