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Study of the role of the transverse perineal muscles during rectal filling

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The function of perineal muscles at defecation is poorly addressed in the literature. We investigated the hypothesis that rectal distension effects reflex contraction of four perineal muscles.

Patient/methods

After rectal balloon distension with carbon dioxide in increments of 20 ml, the responses of electromyographic (EMG) activity of superficial (STPM) and deep (DTPM) transverse perineal muscles as well as the rectal pressure were recorded in 22 healthy volunteers (14 men, age 37.2±6.3 years). Responses were registered again after individual anesthetization of rectum and transverse perineal muscles. Tests were repeated using saline instead of lidocaine.

Results/findings

Rectal balloon distension in big volumes effected increase of the transverse perineal muscles’ EMG activity and rectal pressure. The more the rectum was distended, the more the rectal pressure and EMG activity of the transverse perineal muscles were increased. The latency showed a gradual decrease upon incremental rectal distension increase. Transverse perineal muscles did not respond to rectal distension after the rectum and perineal muscles had been individually anesthetized, but it responded to saline administration. Response of the muscles was similar in both sides.

Interpretation/conclusion

Increase of rectal pressure increases EMG activity of transverse perineal muscles. This action seems mediated through a reflex which we call ‘recto-perineal reflex’. Contraction of transverse perineal muscles at defecation presumably supports the perineal floor. It also protects transverse perineal muscles against straining-produced high pressure that is transmitted through the recto-vaginal/-vesical cul de sac to the perineum which may sag down and share in genesis of perineocele, enterocele, or sigmoidocele.

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Abbreviations

EMG :

Electromyographic

STPM :

Superficial transverse perineal muscles

DTPM :

Deep transverse perineal muscles

SD :

Standard deviation

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Acknowledgements

Margot Yehia assisted in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, 2 Talaat Harb Street, Cairo, 11121, Egypt

    Ahmed Shafik, Ali A. Shafik & Ismail Shafik

  2. Department of Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt

    Olfat El-Sibai

Authors
  1. Ahmed Shafik
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  2. Ali A. Shafik
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  3. Ismail Shafik
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  4. Olfat El-Sibai
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Corresponding author

Correspondence to Ahmed Shafik.

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Shafik, A., Shafik, A.A., Shafik, I. et al. Study of the role of the transverse perineal muscles during rectal filling. Int J Colorectal Dis 21, 698–704 (2006). https://doi.org/10.1007/s00384-005-0062-9

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  • DOI: https://doi.org/10.1007/s00384-005-0062-9

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