Skip to main content
SpringerLink
Log in

Anorectal and Pelvic Floor Physiology

  • Chapter
Anorectal and Colonic Diseases

  • 1729 Accesses

Abstract

Normal continence and defecation is achieved through a complex interaction between peroral intake, the upper gastrointestinal tract (digestion, secretion and propulsion), and colorectoanal function. Accordingly, continence and defecation can be severely disturbed secondary to abnormal eating patterns or disturbed digestion and propulsion in the small bowel. This is, however, outside the scope of the present chapter. In clinical practice anorectal function cannot be interpreted without considering colonic function, which is therefore included in the following discussion. The main functions of the colorectum are absorption (water, electrolytes, and short-chain fatty acids), transport, and storage. Absorption occurs mainly in the right colon. The main function of the left colon is storage of stools and, together with the rectum, the pelvic floor, and the anal canal, it is responsible for continence and defecation. The mechanisms underlying continence and defecation are interdependent, and in the majority of patients with functional problems both are affected to a varying degree.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 299.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 379.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abrahamsson H, Antov S, Bosaeus I (1988) Gastrointestinal and colonic segmental transit time evaluated by a single abdominal x-ay in healthy subjects and constipated patients. Scand J Gastroenterol 23:72–80

    Article  Google Scholar 

  2. Arhan P, Devroede G, Jehannin B, et al (1981) Segmental colonic transit time. Dis Colon Rectum 24:625–629

    Article  CAS  PubMed  Google Scholar 

  3. Bartram CI (2005) Functional anorectal imaging. Abdom Imaging 30:195–203

    Article  CAS  PubMed  Google Scholar 

  4. Bassotti G, Gaburri M, Imbimbo BP, et al (1988) Colonic mass movements in idiopathic chronic constipation. Gut 29:1173–1179

    Article  CAS  PubMed  Google Scholar 

  5. Bharucha AE (2006) Update of tests of colon and rectal structure and function. J Clin Gastroenterol 40:96–103

    Article  PubMed  Google Scholar 

  6. Bharuha AE (1997) Adrenergic modulation. Am J Physiol 273:G997–1006

    Google Scholar 

  7. Bouchoucha M, Delvaux M, The Worhing Team (1997) Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. Dig Dis Sci 2:223–241

    Google Scholar 

  8. Cook IJ, Furukawa Y, Panagopoulos V, et al (2000) Relationships between spatial patterns of colonic pressure and individual movements of content. Am J Physiol 278:G329–G341

    CAS  Google Scholar 

  9. Daniel EE, Berezin I (1992) Interstitial cells of Cajal are they major players in control of gastrointestinal motility. J Gastrointest Motil 4:1–24

    Google Scholar 

  10. Denny-Brown D, Robertson EG (1935) An investigation of the nervous control of defecation. Brain 58:256–310

    Article  Google Scholar 

  11. Duthie HL, Bennet RC (1963) The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut 4:197–182

    Google Scholar 

  12. Enck P, Greving I, Klosterhalfen S, et al (2006) Upper and lower gastrointestinal motor and sensory dysfunction after human spinal cord injury. Prog Brain Res 152:373–384

    Article  PubMed  Google Scholar 

  13. Ferra A, Pemberton JH, Levin KE, et al (1993) Relationship between anal canal tone and rectal motor activity. Dis Colon Rectum 36:337–342

    Article  Google Scholar 

  14. Gayton AC, Hall JE (1996) Textbook of Medical Physiology, 9th edn. Saunders, Philadelphia

    Google Scholar 

  15. Goligher JC, Hughes ESR (1951) Sensibility of the rectum and colon. Its role the mechanism of anal continence. Lancet 1:543–547

    Article  CAS  PubMed  Google Scholar 

  16. Gregersen H, Ehrlein H-J (1996) Motility studies in laboratory animals. In: Jensen SL, Gregersen H, Shokouh-Amiri MH, Moody F (eds) Essentials of Experimental Surgery: Gastroenterology. Harwood Academic Publishers, New York, pp 17/1–17/39

    Google Scholar 

  17. Herbst F, Kamm MA, Morris GP, et al (1997) Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence. Gut 41:381–389

    CAS  PubMed  Google Scholar 

  18. Keighley MRB, Williams NS (1997) Surgery of the Anus, Rectum and Colon (2nd edn), vol. 1. Bailliere Tindall, London

    Google Scholar 

  19. Kiff ES, Swash M (1984) Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. J Neurol Neurosurg Psychiatry 47:820–823

    Article  CAS  PubMed  Google Scholar 

  20. Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 12:3168–3173

    PubMed  Google Scholar 

  21. Krogh K, Ryhammer AM, Lundby L, et al (2001) Comparison of methods used for measurement of rectal compliance. Dis Colon Rectum 44:199–206

    Article  CAS  PubMed  Google Scholar 

  22. Krogh K, Mosdal C, Gregersen H, et al (2002) Rectal wall properties in patients with acute and chronic spinal cord lesions. Dis Colon Rectum. 45:641–649

    Article  CAS  PubMed  Google Scholar 

  23. Krogh K, Olsen N, Christensen P, et al (2003) Colorectal transport during defecation in patients with lesions of the sacral spinal cord. Neurogastroenterol Motil 15:25–31

    Article  CAS  PubMed  Google Scholar 

  24. Lestar B, Pennickx F, Kerremans R (1989) The composition of anal basal pressure. Int J Colorectal Dis 4:118–122

    Article  CAS  PubMed  Google Scholar 

  25. Madoff RD, Orrom WJ, Rothenberger DA, et al (1990) Rectal compliance: a critical reappraisal. Int J Colorectal Dis 5:37–40

    Article  CAS  PubMed  Google Scholar 

  26. Mandrek K, Golenhofen K (1990) Phasic-rhythmical and tonic components in gastrointestinal motility. In: Sperelakis N, Wood JD (eds) Frontiers in Smooth Muscle Research. Wiley-Liss, New York, pp 463–481

    Google Scholar 

  27. Maslekar S, Gardiner A, Maklin C, et al (2006) Investigation and treatment of faecal incontinence. Postgrad Med J 82:363–371

    Article  CAS  PubMed  Google Scholar 

  28. Mortele KJ, Fairhurst J (2007) Dynamic MR defecography of the posterior compartment: indications, techniques and MRI features. Eur J Radiol 61:462–472

    Article  PubMed  Google Scholar 

  29. Onuf B (1900) On the arrangement and function of the cell groups of the sacral region of the spinal cord in man. Arch Neurol Psychopathology 3:387–412

    Google Scholar 

  30. Person B, Wexner SD (2005) Advances in surgical treatment of fecal incontinence. Surg Innov 12:7–21

    Article  PubMed  Google Scholar 

  31. Rao SSC (2004) Pathophysiology of adult fecal incontinence. Gastroenterol 126:S14–S22

    Article  Google Scholar 

  32. Rao SSC, Welcher K (1996) Periodic rectal motor activity: the intrinsic colonic gatekeeper. Am J Gastroenterol 91:890–897

    CAS  PubMed  Google Scholar 

  33. Rao SSC, Sadeghi P, Beaty J, et al (2001) Ambulatory 24-h manometry in healthy humans. Am J Physiol 280:G629–G639

    CAS  Google Scholar 

  34. Rogers J (1992) Rectal and anal sensation. In: Henry M, Swash MM (1992) Coloproctology and the Pelvic Floor. Butterworth-Heineman, Oxford, pp 54–60

    Google Scholar 

  35. Schwizer W, Steingoetter A, Fox M (2006) Magnetic resonance imaging for the assessment of gastrointestinal function. Scand J Gastroenterol 41:1245–1260

    Article  PubMed  Google Scholar 

  36. Snooks SJ, Barnes PRH, Swash M, et al (1985) Damage to the innervation of the pelvic floor musculature in chronic constipation. Gastroenterology 89:977–981

    CAS  PubMed  Google Scholar 

  37. Sorensen SM, Gregersen H, Sorensen S, et al (1989) Spontaneous anorectal pressure activity: evidence of internal anal sphincter contractions in response to rectal pressure waves. Scand J Gastroenterol 24:115–200

    Article  CAS  PubMed  Google Scholar 

  38. Sultan AH, Kamm MA, Talbot IC, et al (1994) Anal sphincter endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 81:463–465

    Article  CAS  PubMed  Google Scholar 

  39. Wald A (2005) Pathophysiology, diagnosis and current management of chronic constipation. Nat Clin Pract Gastroenterol Hepatol 3:90–100

    Article  Google Scholar 

  40. Waldron DJ, Kumar D, Hallan RI, et al (1989) Prolonged ambulant assessment of anorectal function in patients with prolapsing hemorrhoids. Dis Colon Rectum 32:968–974

    Article  CAS  PubMed  Google Scholar 

  41. Wood JD, Alpers DH, Andrews PLR (1999) Fundamentals of neurogastroenterology. Gut 45:II6–II16

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Aarhus University Hospital, 8000, Aarhus, Denmark

    Søren Laurberg

  2. Neurogastroenterology Unit Departments of Hepatology and Gastroenterology V. and Surgery P, Aarhus University Hospital, Aarhus, Denmark

    Klaus Krogh

Authors
  1. Søren Laurberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Krogh
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland

    Jean-Claude R. Givel

  2. Department of Colorectal Surgery, The John Radcliffe Hospital, OX3 9DU, Headington, Oxford, UK

    Neil Mortensen

  3. Responsable de l’Unité de Proctologie, Hôpital Cantonal Universitaire de Genève, Rue Gabrielle Perret-Gentil 4, 1211, Genève 14, Switzerland

    Bruno Roche

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Laurberg, S., Krogh, K. (2010). Anorectal and Pelvic Floor Physiology. In: Givel, JC., Mortensen, N., Roche, B. (eds) Anorectal and Colonic Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69419-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-69419-9_2

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69418-2

  • Online ISBN: 978-3-540-69419-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation