Basic Anatomy and Physiology of Bowel Control

  • Alberto Peña
  • Andrea Bischoff
Chapter

Abstract

The authors present a summary of the most recent publications related with the etiology, pathogenesis, and genetics of anorectal malformations. Special attention is dedicated to the issue of the “modern anatomic findings.” A detailed description of the intrinsic anatomy of anorectal malformations is presented, in an effort to eradicate traditional concepts, based on repetition of myths and “sacred” concepts, without factual evidence such as the characteristics of the “internal sphincter,” “external sphincter,” and “puborectalis muscle.”

A brief description of the most important elements necessary to have bowel control is presented including (a) sensation, (b) sphincters, and (c) colonic motility. Contrary to the common belief, the authors emphasize the importance of rectosigmoid and colonic motility surpassing the traditional concept that the main important element for bowel control is the sphincter mechanism.

The authors present a classification of anorectal malformations, based on therapeutic and prognostic factors.

Keywords

Fecal Incontinence Anal Canal Bladder Neck External Sphincter Internal Sphincter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Supplementary material

Animation 2.1

Sphincter contraction in a normal human body (WMV 6049 kb)

Animation 2.2

Sphincter contraction in a perineal fistula (WMV 9281 kb)

Animation 2.3

Sphincter contraction in a rectourethral bulbar fistula (WMV 8929 kb)

Animation 2.4

Sphincter contraction in a prostatic fistula (WMV 9185 kb)

Animation 2.5

Sphincter contraction of a recto-bladder neck fistula (WMV 8865 kb)

Animation 2.6

Dynamic representation of the spectrum of anorectal malformations (WMV 10016 kb)

References

  1. 1.
    Stephens D, Smith D (1972) Ano-rectal malformation in children. Year Book Medical Publisher, Inc, Chicago, pp 14–32Google Scholar
  2. 2.
    Oh C, Kark AE (1972) Anatomy of the external anal sphincter. Br J Surg 59(9):717–723CrossRefPubMedGoogle Scholar
  3. 3.
    Lawson JO (1974) Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl 54(5):244–252PubMedCentralPubMedGoogle Scholar
  4. 4.
    Fucini C, Elbetti C, Messerini L (1999) Anatomic plane of separation between external anal sphincter and puborectalis muscle: clinical implications. Dis Colon Rectum 42(3):374–379CrossRefPubMedGoogle Scholar
  5. 5.
    Gil-Vernet JM, Torán N, Sanchís LF, Marhuenda C (1988) Consideraciones a la anatomía del esfínter externo anal en la atresia anorrectal alta. [Anatomy of the external anal sphincter in high anorectal atresia]. Cir Pediatr 1(2):62–65PubMedGoogle Scholar
  6. 6.
    Ikawa H, Yokoyama J, Sanbonmatsu T, Hagane K, Endo M, Katsumata K, Kohda E (1985) The use of computerized tomography to evaluate anorectal anomalies. J Pediatr Surg 20(6):640–644CrossRefPubMedGoogle Scholar
  7. 7.
    Aronson MP, Lee RA, Berquist TH (1990) Anatomy of anal sphincters and related structures in continent women studied with magnetic resonance imaging. Obstet Gynecol 76(5 Pt 1):846–851CrossRefPubMedGoogle Scholar
  8. 8.
    Hussain SM, Stoker J, Zwamborn AW, Den Hollander JC, Kuiper JW, Entius CA, Laméris JS (1996) Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology. J Anat 189(Pt 3):677–682PubMedCentralPubMedGoogle Scholar
  9. 9.
    Guo M, Li D (2007) Pelvic floor images: anatomy of the levator ani muscle. Dis Colon Rectum 50(10):1647–1655CrossRefPubMedGoogle Scholar
  10. 10.
    Li D, Guo M (2007) Morphology of the levator ani muscle. Dis Colon Rectum 50(11):1831–1839CrossRefPubMedGoogle Scholar
  11. 11.
    Tang ST, Cao GQ, Mao YZ, Wang Y, Li SW, Yang Y, Tong QS (2009) Clinical value of pelvic 3-dimensional magnetic resonance image reconstruction in anorectal malformations. J Pediatr Surg 44(12):2369–2374. doi: 10.1016/j.jpedsurg.2009.07.074 CrossRefPubMedGoogle Scholar
  12. 12.
    Guo M, Gao C, Li D, Guo W, Shafik AA, Zbar AP, Pescatori M (2010) MRI anatomy of the anal region. Dis Colon Rectum 53(11):1542–1548. doi: 10.1007/DCR.0b013e3181f05256 CrossRefPubMedGoogle Scholar
  13. 13.
    Watanabe Y, Takasu H, Sumida W, Mori K (2013) Wide variation in anal sphincter muscles in cases of high- and intermediate-type male anorectal malformation. Pediatr Surg Int 29(4):369–373. doi: 10.1007/s00383-012-3250-z CrossRefPubMedGoogle Scholar
  14. 14.
    Shafik A (1980) A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. X. Anorectal sinus and band: anatomic nature and surgical significance. Dis Colon Rectum 23(3):170–179CrossRefPubMedGoogle Scholar
  15. 15.
    Zbar AP, Guo M, Pescatori M (2008) Anorectal morphology and function: analysis of the Shafik legacy. Tech Coloproctol 12(3):191–200. doi: 10.1007/s10151-008-0417-7 CrossRefPubMedGoogle Scholar
  16. 16.
    Konerding MA, Dzemali O, Gaumann A, Malkusch W, Eckardt VF (1999) Correlation of endoanal sonography with cross-sectional anatomy of the anal sphincter. Gastrointest Endosc 50(6):804–810CrossRefPubMedGoogle Scholar
  17. 17.
    Dalley AF 2nd (1987) The riddle of the sphincters. The morphophysiology of the anorectal mechanism reviewed. Am Surg 53(5):298–306PubMedGoogle Scholar
  18. 18.
    Frenckner B, Euler CV (1975) Influence of pudendal block on the function of the anal sphincters. Gut 16(6):482–489CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Penninckx F, Lestar B, Kerremans R (1992) The internal anal sphincter: mechanisms of control and its role in maintaining anal continence. Baillieres Clin Gastroenterol 6(1):193–214CrossRefPubMedGoogle Scholar
  20. 20.
    Varma KK, Stephens D (1972) Neuromuscular reflexes of rectal continence. Aust N Z J Surg 41(3):263–272CrossRefPubMedGoogle Scholar
  21. 21.
    Holschneider AM, Ure BM, Pfrommer W, Meier-Ruge W (1996) Innervation patterns of the rectal pouch and fistula in anorectal malformations: a preliminary report. J Pediatr Surg 31(3):357–362CrossRefPubMedGoogle Scholar
  22. 22.
    Holschneider AM, Pfrommer W, Gerresheim B (1994) Results in the treatment of anorectal malformations with special regard to the histology of the rectal pouch. Eur J Pediatr Surg 4(5):303–309CrossRefPubMedGoogle Scholar
  23. 23.
    Lambrecht W, Lierse W (1987) The internal sphincter in anorectal malformations: morphologic investigations in neonatal pigs. J Pediatr Surg 22(12):1160–1168CrossRefPubMedGoogle Scholar
  24. 24.
    Rintala R, Lindahl H, Marttinen E, Sariola H (1993) Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations. J Pediatr Surg 28(8):1054–1058CrossRefPubMedGoogle Scholar
  25. 25.
    Stephens D, Smith D (1972) Ano-rectal malformation in children. Year Book Medical Publisher, Inc, Chicago, pp. 212–273Google Scholar
  26. 26.
    Pearl RK, Monsen H, Abcarian H (1986) Surgical anatomy of the pelvic autonomic nerves. A practical approach. Am Surg 52(5):236–237PubMedGoogle Scholar
  27. 27.
    Duthie HL, Gairns FW (1960) Sensory nerve-endings and sensation in the anal region of man. Br J Surg 47:585–595CrossRefPubMedGoogle Scholar
  28. 28.
    Turell R, Krakauer JS, De Maynard AL (1953) Colonic and anorectal function and disease. Surg Gynecol Obstet 96(4):313–339; contdPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Alberto Peña
    • 1
  • Andrea Bischoff
    • 1
  1. 1.Pediatric SurgeryColorectal Center for Children Cincinnati Children’s HospitalCincinnatiUSA

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