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Trunk Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Rowan Sherwood
The external anal sphincter is a circular muscle that surrounds the anus (Liu and Salem 2016; Standring 2016). It extends between the perineal body and the anococcygeal raphe (Liu and Salem 2016; Standring 2016). The deep part of the external anal sphincter blends with puborectalis (Liu and Salem 2016; Standring 2016). Fibers from the transverse perineal muscles and bulbospongiosus pass to the external anal sphincter (Peikert et al. 2015; Standring 2005, 2016). The anterior portion of the muscle is shorter in females (Sultan et al. 1994).
Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Faecal impaction or diarrhoea are both frequent precipitants in nursing home populations. In a community-based sample of people (aged 65–93 years) around 60% of those with FI had either an associated chronic diarrhoea or constipation.4 Other risk factors include the presence of neurological disease, reduced mobility, cognitive decline and old age.56 Laxatives may be a precipitant. FI can occur with overflow diarrhoea secondary to faecal impaction (see next section). Autonomic neuropathy in diabetes may induce diarrhoea and FI. It commonly develops in advanced dementia where, similar to urinary problems, there may be reduced mobility, decreased awareness of the need to defecate or disinhibited behaviour. It frequently occurs in the early post-stroke period when both cognition and mobility can be impaired. It can also be precipitated by neurological conditions affecting sphincter function. FI in older people is associated with a reduced anal resting pressure and reduced anal sensation.57 Internal anal sphincter dysfunction may be an important factor. Rectal prolapse and subsequent disruption of the innervation can provoke FI, which is more common in post-partum women.58 The causation of FI is often multi-factorial in frail older people and a ‘proctoscopic' view, that focuses only on the bowel and stool, should be avoided.
Colorectal Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Jennie Grainger, Samson Tou, Steve Schlichtemeier, William Speake, Fung Joon Foo, Frank McDermott
When offering pouch surgery, what other aspects do you need to consider?Good anal sphincter function – risk of incontinence is high if not.Exclude Crohn's disease (high failure rate).Should not be performed in patients with active anal lesions (fissure, anorectal sepsis or ulceration).Exclude sclerosing cholangitis (relatively contraindicated due to high incidence of pouchitis).Fecundity – decrease in female infertility after pouch surgery (likely due to the rectal dissection), so either delay surgery or accept the risk of reduced fertility, which can generally be overcome with in-vitro fertilisation techniques.
Current development and clinical applications of artificial anal sphincter
Published in Expert Review of Medical Devices, 2023
Minghui Wang, Yunlong Liu, Qingjun Nong, Hongliu Yu
Artificial anal sphincters in animal studies and clinical applications are analyzed in this paper. The performance comparison of different artificial sphincter systems is shown in Table 1. The actuation principles, power supply type, rectal perception function, biomechanical compatibility and progressive stage are considered in this table to compare the existing artificial anal sphincters, which show that the existing artificial anal sphincters have different design concepts and functions. Four types of the existing artificial anal sphincters have entered clinical studies. The details of the clinical studies for artificial anal sphincter are shown in Table 2. The results of clinical studies indicate that each artificial anal sphincter has some complications.
Delivery outcomes in women with morbid obesity, where induction of labour was planned to prevent post-term complications
Published in Journal of Obstetrics and Gynaecology, 2022
J. D. Kammies, L. De Waard, C. J. B. Muller, D. R. Hall
Regarding maternal complications, more patients undergoing IOL had an estimated blood loss of 500 ml or more, compared to those in spontaneous labour (31% vs. 13%, respectively, p = .0164). Eighteen (15%) patients developed pregnancy hypertension, including ten with gestational hypertension and eight with late-onset pre-eclampsia. Of the eight with pre-eclampsia, six patients required an emergency CS. There was no difference in the proportions of patients developing hypertension on account of their labour onset. Three patients sustained obstetric anal sphincter injury, two after spontaneous labour and one after induction. Two patients required antibiotic therapy treatment for infection. One case developed wound sepsis after IOL followed later by emergency CS with blood loss of 2000 ml. The second case involved an HIV positive primigravida on antiretroviral therapy with a suppressed viral load, who developed urinary sepsis post-CS for cephalopelvic disproportion. Pulmonary embolism was diagnosed in one patient, a 23-year-old, with a BMI of 48.7 kg/m2 who underwent IOL but required emergency CS for a pathological CTG. The embolism was detected post-operatively during investigation for persistent maternal tachycardia.
Clinical value of positive BET and pelvic floor dyssynergia in Chinese patients with functional defecation disorder
Published in Scandinavian Journal of Gastroenterology, 2022
Ya Jiang, Yan Wang, Yurong Tang, Lin Lin
84.48% patients with FDD in our study were found showing positive BET and PFD, revealing good agreement between positive BET and PFD. These patients showed high anal residual pressure, low anal relaxation rate, RAPG and MDI. During normal defecation, there is a rise in rectal pressure, which is synchronized with a relaxation of the external anal sphincter and a decrease in anal pressure. The inability to perform this coordinated movement represents the main pathophysiological mechanism in FDD. This may be related to inadequate pushing force, paradoxical anal sphincter contraction, impaired anal sphincter relaxation, or a combination of above [36,37]. Anal residual pressure indicates whether there is a failure in anal relaxation during attempted defecation. Besides, the quantitative parameters of pressure changes in the rectum and anus during attempted defecation, such as anal relaxation rate, MDI and RAPG, are useful to diagnose FDD [15] and MDI serves as a simple and useful quantitative measure of rectoanal coordination during defecation [38]. According to our findings, FDD patients with positive BET and PFD mainly had problems with impaired anal sphincter relaxation and paradoxical anal sphincter contraction, which may be associated with abnormal external anal sphincter (EAS) and/or puborectalis muscle contraction [21].