Influence of pudendal block on the function of the anal sphincters.

Frenckner, Björn; Euler, Curt von

doi:10.1136/gut.16.6.482

Cited by 349 publications

(132 citation statements)

References 9 publications

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“…In contrast to incontinence related to external sphincter dysfunction, treatment options are limited in patients having impairment of the internal anal sphincter (IAS) and passive incontinence. In fact, IAS provides most of the resting anal pressure: 3,4 degeneration or disruption of the IAS characteristically leads to passive incontinence. Structural damage may result from childbirth trauma, surgical trauma such as sphincterotomy or fistula surgery, or other accidental trauma.…”

Section: Introductionmentioning

confidence: 99%

Elastomer implants in faecal incontinence: a blind, randomized placebo‐controlled study

Siproudhis¹,

Morçet

Lainé

2007

Aliment Pharmacol Ther

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AimTo test efficacy and safety of polydimethylsiloxane elastomer implants, a silicone biomaterial, in patients with severe faecal incontinence related to an impaired internal anal sphincter. MethodsSubjects were randomized to receive three injections of 2.5 mL of either physiological saline or polydimethylsiloxane elastomer. After local anaesthesia, an 18 gauge, 2.5-in needle was inserted through the perianal skin and laid down into the intersphincteric space. Treatment (saline or polydimethylsiloxane elastomer) was administered by means of a ratchet gun. Three injections of 2.5 mL each were performed in the area of the internal anal sphincter at 3, 7 and 11 o'clock positions. Main end point was the percentage of subjects in each treatment arm experiencing a successful treatment, defined as a Cleveland Clinic FloridaFaecal Incontinence score <8, 3 months after treatment. Secondary end points were quality of life scores, weekly number of faecal incontinence episodes, subject acceptance and adverse events rate. Both patients and end point assessments were blinded to treatment.Results 44 women (64.3 AE 9 years) with a baseline Cleveland Clinic FloridaFaecal Incontinence score ‡8 were enrolled prospectively; 22 received polydimethylsiloxane elastomer and 22 saline treatment. Treatment was well tolerated. At 3 months, the percentage of subjects experiencing a successful treatment was not different between polydimethylsiloxane elastomer and saline groups (23% vs. 27%, respectively, P = 0.73). Moreover, Cleveland Clinic Florida-Faecal Incontinence score was not significantly different between polydimethylsiloxane elastomer and saline groups (11.7 AE 4.7 vs. 11.4 AE 4.5, respectively, P = 0.79). ConclusionsPolydimethylsiloxane elastomer implants cannot be recommended for treatment of severe faecal incontinence related to impaired internal anal sphincter.

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Section: Introductionmentioning

confidence: 99%

Elastomer implants in faecal incontinence: a blind, randomized placebo‐controlled study

Siproudhis¹,

Morçet

Lainé

2007

Aliment Pharmacol Ther

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“…At rest, the IAS is in a tonically contracted state, and is innervated by the autonomic nervous system. The IAS plays a key role in maintaining continence, providing 55% -85% of MRP [3,4]. Several studies have investigated the effect of sex on resting pressure of the anal canal [12][13][14][15].…”

Section: Resultsmentioning

confidence: 99%

“…Although both sphincter muscles are important for the maintenance of continence, the IAS, composed of smooth muscle arranged in oblique bundles, provides most of the resting anal tone and is the main muscle responsible for preventing fecal leakage. The IAS contributes an estimated 55% -85% to maximal resting pressure (MRP) [3,4]. Low MRP is the most important predictor of FI and correlates with the Fecal Incontinence Severity Index (FISI) [5].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for internal anal sphincter dysfunction in Japanese adults

Abé¹,

Kono²,

Hachiro³

et al. 2013

OJGas

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Purpose: The internal anal sphincter provides most of the resting anal tone and is the main muscle responseble for continence. This study was designed to estimate the prevalence of, and identify risk factors associated with, internal anal sphincter dysfunction in Japanese adults. Methods: Anorectal manometry was performed in 1193 women and 1124 men aged 20 years or older. The maximal resting pressure, measured by a rapid pull-through technique, was defined as the highest resting pressure recorded. Internal anal sphincter dysfunction was defined as a maximal resting pressure less than 30 mmHg. Potential risk factors were assessed through self-reports, interviews, physical examinations, and medical record reviews. Multivariate logistic regression analysis was used to identify independent risk factors for internal anal sphincter dysfunction. Results: Significant differences in maximal resting pressure were seen between women (58.1 ± 24.9 mmHg) and men (68.8 ± 23.5 mmHg, P < 0.001). Maximal resting pressure decreased significantly with increasing age in both sexes. The prevalence of internal anal sphincter dysfunction was 10.4% (15.5% in women, 5.1% in men). In a multivariate logistic regression model, age, mental disease, pelvic organ prolapse repair, and fecal incontinence were independently associated with a greater risk of internal anal sphincter dysfunction in women and men. Conclusions: Internal anal sphincter dysfunction is a common problem for women and men. Several of the identified risk factors are preventable or modifiable, and may direct future research in fecal incontinence therapy.

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“…and pubo-rectalis, as well as smooth muscle of the i.a.s. (Freckner & von Euler, 1975) and also by the rapid recovery of maximal i.a.s. tone.…”

Section: Discussionmentioning

confidence: 99%

Ano‐rectal activity in man during rectal infusion of saline: a dynamic assessment of the anal continence mechanism.

Haynes¹,

Read²

1982

The Journal of Physiology

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SUMMARY1. Anal and rectal pressures and the external anal sphincter electromyogram were recorded in eighteen normal subjects at rest and during rectal infusion of 1500 ml. saline at a rate of 60 ml./min.2. During saline infusion, the recordings described a pattern of regular relaxations of the internal sphincter associated with contractions of the rectum and the external anal sphincter. The frequency of ano-rectal pressure fluctuations increased as the infusion progressed.3. The peaks in rectal pressure were always lower than the lowest anal pressure in all normal subjects tested.4. External sphincter contractions only occurred in association with 60 % of internal anal sphincter relaxations and did not prevent the maximum decrease in anal pressure. These observations suggest that phasic contraction of the external anal sphincter does not play a major role in maintaining continence.

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Influence of pudendal block on the function of the anal sphincters.

Cited by 349 publications

References 9 publications

Elastomer implants in faecal incontinence: a blind, randomized placebo‐controlled study

Elastomer implants in faecal incontinence: a blind, randomized placebo‐controlled study

Risk factors for internal anal sphincter dysfunction in Japanese adults

Ano‐rectal activity in man during rectal infusion of saline: a dynamic assessment of the anal continence mechanism.

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