Abstract
Anal manometry and anal electromyography (EMG) were performed in 45 patients to evaluate the external anal sphincter. Their symptoms were soiling (N=6), incontinence (N=10), and obstipation (N=10). Clinical diagnoses were previous anal surgery (N=16), rectal prolapse—partial, total, intussusception (N=16), puborectalis syndrome (N=4), neurologic disorders (N=3), and others (N=6). The relationship between the maximum squeeze pressure (MSP) measured with anal manometry and the maximum (voluntary) contraction pattern (MCP) and signs of denervation (DEN) measured with anal EMG were examined. The correlation coefficient between MSP and MCP was 0.55 (P<.001) and between MSP, and DEN 0.13 (NS). A normal MSP always showed a normal MCP, a normal MCP showed an abnormal MSP in 43 percent only. In conclusion, the clinical value of anal EMG seems limited. Assessment of an additional anal EMG seems indicated in incontinent patients with previous anal surgery with a low MSP to estimate muscle function, whenever anal surgery is considered. Anal EMG during straining can easily confirm the clinical diagnosis of puborectalis syndrome.
Article PDF
Similar content being viewed by others
References
Matheson DM, Keighley MR. Manometric evaluation of rectal prolapse and faecal incontinence. Gut 1981; 22:126–9.
Varma JS, Smith AN, Busutil A. Function of the anal sphincters after chronic radiation injury. Gut 1986; 27:528–33.
Read NW, Harford WF, Schmulen AC, Read MG, Santa Ana C, Fordtran JS. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 1979; 76:747–56.
Snooks SJ, Barnes PR, Swash M. Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry 1984; 47:1269–73.
Snooks SJ, Swash M, Henry MM. Abnormalities in central and peripheral nerve conduction in patients with anorectal incontinence. J R Soc Med 1985; 78:294–300.
Swash M. Anorectal incontinence: electrophysiological tests. In: Symposium III. Anorectal incontinence. Br J Surg 1985; 72 (suppl):S14–22.
Felt-Bersma RJF, Klinkenberg-Knol EC, Meuwissen SG. Investigation of anorectal function. Br J Surg 1988; 75:53–5.
Loening-Baucke V, Anuras S. Effects of age and sex on anorectal manometry. Am J Gastroenterol 1985; 80:50–3.
Alva J, Mendeloff AL, Schuster MM. Reflex and electromyographic abnormalities associated with fecal incontinence. Gastroenterology 1967; 53:101–6.
Haynes WG, Read NW. Anorectal activity in man during rectal infusion of saline: a dynamic assessment of the anal continence mechanism. J Physiol 1982; 330:45–56.
Read NW, Haynes WG, Bartolo DC, et al. Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients. Gastroenterology 1983; 85:105–13.
Henry MM, Parks AG, Swash M. The anal reflex in idiopathic faecal incontinence. Br J Surg 1980; 67:781–3.
Neil ME, Parks AG, Swash M. Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse. Br J Surg 1981; 68:531–6.
Bartolo DC, Read NW, Jarratt JA, Read MG, Donnelly TG, Johnson AG. Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent. Gastroenterology 1983; 85:68–75.
Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence Br J Surg 1984; 71: 614–6.
Read NW, Bartolo DC, Read MG. Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 1984; 71:39–42.
Varma JS, Smith AN, McInnes A. Electrophysiological observations on the human pudendo-anal reflex. J Neurol Neurosurg Psychiatry 1986; 49:1411–6.
Melange M, Vanderheuverzwijn R, Mahieu P, et al. L'ulcere solitaire du rectum: un syndrome. Acta Gastroenterol Belg 1985; 48: 140–7.
Keighley MR, Shouler P. Clinical and manometric features of the solitary rectal ulcer syndrome. Dis Colon Rectum 1984; 27:507–12.
Kuijpers HC, Bleijenberg MD. The spastic floor syndrome: a cause of constipation. Dis Colon Rectum 1985; 28:669–72.
Varma JS, Smith AN. Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum. Br J Surg 1986; 73:285–9.
Sharp FR, Bell GA, Seal AM, Atkinson KG. Investigations of the anal sphincter before and after restorative proctocolectomy. Am J Surg 1987; 153:469–72.
Parks AG. Anorectal incontinence. Proc R Soc Med 1975; 68: 681–90.
Keighley MR, Fielding JW. Management of faecal incontinence and results of surgical treatment. Br J Surg 1983; 70:463–8.
Fang DT, Nivatvongs S, Vermeulen FD, Herman FN, Goldberg SM, Rothenberger DA, Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 1984; 27:720–2.
Motson RW. Sphincter injuries: indications for, and results of sphincter repair. Br J Surg 1985; 72(suppl):S19–21.
Author information
Authors and Affiliations
About this article
Cite this article
Felt-Bersma, R.J.F., Strijers, R.L.M., Janssen, J.J.W.M. et al. The external anal sphincter. Dis Colon Rectum 32, 112–116 (1989). https://doi.org/10.1007/BF02553822
Issue Date:
DOI: https://doi.org/10.1007/BF02553822