Abstract
PURPOSE: This study was designed to investigate the function and morphology of anal sphincters in patients with an idiopathic megarectum. METHODS: A total of 17 patients were studied by anal endosonography and manometry when not impacted. Fourteen had previously been manually disimpacted under general anesthetic, and three had not. RESULTS: Nine of 14 patients in the former group, but none of the latter group, had disruption of one or both anal sphincter muscles on endosonography. Endosonographic changes were characteristic of those identified previously in patients following anal dilation. Low anal resting pressure, indicative of internal sphincter dysfunction, was found in a substantial proportion of patients with either an endosonographically intact or disrupted internal anal sphincter. Voluntary contraction increment, a reflection of external sphincter function, was normal in all patients. CONCLUSION: Manual disimpaction under general anesthetic appears to be associated with iatrogenic structural injury to the anal sphincters. In some patients, this may contribute to sphincter weakness. This damage may contribute to the incontinence experienced by patients with a dilated rectum.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kamm MA, Stabile G. Management of idiopathic megarectum and megacolon. Br J Surg 1991;78:899–900.
Stabile G, Kamm MA, Hawley PR, Lennard-Jones JE. Colectomy for idiopathic megarectum and megacolon. Gut 1991;32:1538–40.
Kamm MA. Investigation and management of megarectum and megacolon. Hosp Update 1993:280–8.
Preston DM, Lennard-Jones JE, Thomas BM. Towards a radiologic definition of idiopathic megacolon. Gastrointest Radiol 1985;10:167–9.
Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg 1991;78:312–4.
Sultan AH, Nicholls RJ, Kamm MA, Hudson CN, Beynon J, Bartram CI. Anal endosonography and correlation within vitro andin vivo anatomy. Br J Surg 1993;80:508–11.
Sultan AH, Kamm MA, Hudson CN, Nicholls RJ, Bartram CI. Endosonography of the anal sphincters: normal anatomy and comparison with manometry. Clin Radiol 1994;49:368–74.
Sultan AH, Kamm MA, Nicholls RJ, Bartram CI. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Col Rectum 1994;37:1031–3.
Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 1994;81:463–5.
Speakman CT, Burnett SJ, Kamm MA, Bartram CI. Sphincter injury after anal dilation demonstrated by anal endosonography. Br J Surg 1991;78:1429–30.
Barnes PR, Lennard-Jones JE. Function of the striated anal sphincter during straining in control subjects and constipated patients with a radiologically normal rectum or idiopathic megacolon. Int J Colorectal Dis 1988;3:207–9.
Read NW, Sun WM. Anorectal manometry. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. 2nd ed. 1992:119–45.
Delechenaut P, Leroi AM, Weber J, Touchais JY, Czernichow P, Denis Ph. Relationship between clinical symptoms of anal incontinence and the results of anorectal manometry. Dis Colon Rectum 1992;35:847–9.
Engel AF, Kamm MA, Bartram CI, Nicholls J. Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorectal Dis 1995;10:152–5.
Jameson JS, Chia YW, Kamm MA, Speakman CT, Chye YH, Henry MM. The effect of age, sex and parity on anorectal function. Br J Surg 1994;81:1689–92.
Nielsen MB, Rasmussen OO, Pedersen JF, Christiansen J. Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano: an endosonographic study. Dis Colon Rectum 1993;36:677–80.
Burnett SJ, Bartram CI. Endosonographic variations in the normal internal anal sphincter. Int J Colorectal Dis 1991;6:2–4.
Bennett RC, Duthie HL. The functional importance of the internal anal sphincter. Br J Surg 1964;51:355–7.
McHugh SM, Diamant NE. Effect of age, gender, and parity on anal canal pressures: contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 1987;32:726–36.
Author information
Authors and Affiliations
Additional information
Dr. Gattuso was supported by the Alimentary Pharmacology and Therapeutics Trust and the British Digestive Foundation.
No reprints are available.
About this article
Cite this article
Gattuso, J.M., Kamm, M.A., Halligan, S.M. et al. The anal sphincter in idiopathic megarectum. Dis Colon Rectum 39, 435–439 (1996). https://doi.org/10.1007/BF02054060
Issue Date:
DOI: https://doi.org/10.1007/BF02054060