Abstract
PATIENT HISTORY: We present a case of anismus in a 36-year-old patient. He complained of therapy refractory constipation that had been present for 15 years, with delayed micturition and voiding by stages. METHODS AND RESULTS: During digital examination of the anal canal, we found spontaneous contractions of the sphincters at rest. The urethral pressure profile showed irregular contractions during micturition. The electromyogram, which was performed with concentric needle electrodes from the external anal sphincter, puborectalis, and external vesical sphincter, revealed synchronous contractions of these muscles. Injections of botulinum toxin into the sphincters showed good effects and no incontinence. CONCLUSION: Focal dystonia of the striated anal and vesical sphincters is a very rare cause of constipation but should be included in the differential diagnosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome: a cause of constipation. Dis Colon Rectum 1985;28:669–72.
Preston DM, Lennard-Jones JE. Anismus in chronic constipation. Dig Dis Sci 1985;30:413–8.
Parks AG, Porter NH, Melzak J. Experimental study of the reflex mechanism controlling the muscles of the pelvic floor. Dis Colon Rectum 1962;5:407–14.
Jones PN, Lubowski DZ, Swash M, Henry MM. Is paradoxical contraction of puborectalis muscle of functional importance? Dis Colon Rectum 1987;30:667–70.
Preston DM, Lennard-Jones JE, Thomas BM. The balloon proctogramm. Br J Surg 1984;71:29–32.
Jost WH, ed. Neurology of the pelvic floor. London: Chapman & Hall, 1997.
Jost WH, Raulf F, Schimrigk K. Anismus: definition, pathophysiologie, diagnose und therapie. Kontinenz 1994;3:211–5.
Mathers SE, Kempster PA, Swash M,et al. Constipation and paradoxical puborectalis contraction in anismus and Parkinson's disease: a dystonic phenomenon? J Neurol Neurosurg Psychiatry 1988;51:1503–7.
Buie LA. Practical proctology. 2nd ed. Springfield: Charles C. Thomas, 1960:163.
Bleijenberg G, Kuijpers HC. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 1987;30:108–11.
Kamm MA, Hawley PR, Lennard-Jones JE. Lateral division of the puborectalis muscle in the management of severe constipation. Br J Surg 1988;75:661–3.
Wasserman IF. Puborectalis syndrome (rectal stenosis due to anorectal spasm). Dis Colon Rectum 1964;7:87–98.
Yoshioka K, Keighley MR. Anorectal myectomy for outlet obstruction. Br J Surg 1987;74:373–6.
Hallan RI, Williams NS, Melling J, Waldron DJ, Womack NR, Morrison JF. Treatment of anismus in intractable constipation with botulinum A toxin. Lancet 1988;2:714–6.
Author information
Authors and Affiliations
About this article
Cite this article
Jost, W.H., Müller-Lobeck, H. & Merkle, W. Involuntary contractions of the striated anal sphincters as a cause of constipation. Dis Colon Rectum 41, 258–260 (1998). https://doi.org/10.1007/BF02238257
Issue Date:
DOI: https://doi.org/10.1007/BF02238257