Skip to main content

Anatomy and Physiology of Continence

  • Chapter

Abstract

Webster’s dictionary defines continence as “the ability to retain a bodily discharge voluntarily”. The word has its origins from the Latin continere or teuere, which means “to hold”. The anorectum is the caudal end of the gastrointestinal tract, and is responsible for fecal continence and defecation. In humans, defecation is a viscero somatic reflex that is often preceded by several attempts to preserve continence. Any attempt at managing anorectal disorders requires a clear understanding of the anatomy and the integrated physiologic mechanisms responsible for maintaining continence.

Keywords

  • Pelvic Floor
  • Fecal Incontinence
  • Anal Sphincter
  • Anal Canal
  • External Anal 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.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-88-470-0638-6_1
  • Chapter length: 14 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   189.00
Price excludes VAT (USA)
  • ISBN: 978-88-470-0638-6
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   249.99
Price excludes VAT (USA)
Hardcover Book
USD   249.99
Price excludes VAT (USA)

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Cook TA, Mortensen NJ (2002) Colon, rectum, anus, anal sphincters and the pelvic floor. In: Pemberton JH, Swash M et al (eds) The pelvic floor: its function and disorders. Harcourt, London, pp 61–76

    Google Scholar 

  2. Lau ST, Caty MG (2006) Hindgut abnormalities. Surg Clin North Am 86:301–316

    PubMed  CrossRef  Google Scholar 

  3. Mahmoud N, Ross, H; Fry, R (2004) Colon and rectum. In: Towsend CM, Beauchamp RD et al (eds) Sabiston Textbook of Surgery. W.B. Saunders, New York

    Google Scholar 

  4. Hjartardottir S, Nilsson J, Petersen C et al (1997) The female pelvic floor: a dome-not a basin. Acta Obstet Gynecol Scand 76:567–571

    PubMed  CAS  Google Scholar 

  5. Percy JP, Neill ME, Swash M et al (1981) Electrophysiological study of motor nerve supply of pelvic floor. Lancet 1:16–17

    PubMed  CAS  CrossRef  Google Scholar 

  6. Bharucha AE, Klingele CJ (2005) Autonomic and somatic systems to the anorectum and pelvic floor. In: Dyck PJ, Thomas PK, (eds.) Peripheral neuropathy, 4th edn. Elsevier Saunders, Philadelphia, pp 279–298

    Google Scholar 

  7. Williams PL, Warwick R (eds) (1980) Splanchnology. Churchill Livingstone, London

    Google Scholar 

  8. Bharucha AE (2003) Fecal Iincontinence. Gastroenterology 124(6):1672–1685

    PubMed  CrossRef  Google Scholar 

  9. Hoffman S, Orestano F (1967) Histology of the myenteric plexus in relation to rectal biopsy in congenital megacolon. J Pediatr Surg 2:575–577

    CrossRef  Google Scholar 

  10. Weinberg AG (1970) The anorectal myenteric plexus: its relation to hypoganglionosis of the colon. Am J Clin Pathol 54:6370–6420

    Google Scholar 

  11. Horiguchi K, Keef KD, Ward SM (2003) Distribution of interstitial cells of Cajal in tunica muscularis of the canine rectoanal region. Am J Physiol Gastrointest Liver Physiol 284:G756–767

    PubMed  CAS  Google Scholar 

  12. Schroder HD, Reske-Nielsen E (1983) Fiber types in the striated urethral and anal sphincters. Acta Neuropathol 60:278–282

    PubMed  CAS  CrossRef  Google Scholar 

  13. Williams PL, Warwick R (eds) (1980) Neurology. Churchill Livingstone, London

    Google Scholar 

  14. Gonella J, Bouvier M, Blanquet F (1987) Extrinsic nervous control of motility of small and large intestines and related sphincters. Physiol Rev 67:902–961

    PubMed  CAS  Google Scholar 

  15. Nakayama S, Neya T, Yamasato T et al (1979) Activity of the spinal defaecation centre in the guinea pig. Ital J Gastroenterol 11:168–173

    Google Scholar 

  16. Turnbull GK, Hamdy S, Aziz Q et al (1999) The cortical topography of human anorectal musculature. Gastroenterology 117:32–39

    PubMed  CAS  CrossRef  Google Scholar 

  17. Holstege G, Tan J (1987) Supraspinal control of motoneurons innervating the striated muscles of the pelvic floor including urethral and anal sphincters in the cat. Brain 110:1323–1344

    PubMed  CrossRef  Google Scholar 

  18. Chalmers D, Swash M (1987) Selective vulnerability of urinary Onuf motoneurons in Shy-Drager syndrome. J Neurol 234:259–260

    PubMed  CAS  CrossRef  Google Scholar 

  19. Sung JH, Mastri AR, Segal E (1979) Pathology of ShyDrager syndrome. J Neuropathol Exp Neurol 38:353–368

    PubMed  CAS  Google Scholar 

  20. Sherrington CS (1892) Notes on the arrangement of some motor fibres in the lumbosacral plexus. J Physiol 13:672–675

    Google Scholar 

  21. Barber MD, Bremer RE, Thor KB et al (2002) Innervation of the female levator ani muscles. Am J Obstet Gynecol 187:64–71

    PubMed  CrossRef  Google Scholar 

  22. Bremer RE, Barber MD, Coates KW et al (2003) Innervation of the levator ani and coccygeus muscles of the female rat. Anat Rec A Discov Mol Cell Evol Biol 275:1031–1041

    PubMed  CrossRef  Google Scholar 

  23. Pierce LM, Reyes M, Thor KB et al (2003) Innervation of the levator ani muscles in the female squirrel monkey. Am J Obstet Gynecol 188:1141–1147

    PubMed  CrossRef  Google Scholar 

  24. Janig W, Koltzenburg M (1991) Receptive properties of sacral primary afferent neurons supplying the colon. J Neurophysiol 65:1067–1077

    PubMed  CAS  Google Scholar 

  25. Lynn PA, Olsson C, Zagorodnyuk V et al (2003) Rectal intraganglionic laminar endings are transduction sites of extrinsic mechanoreceptors in the guinea pig rectum. Gastroenterology 125:786–794

    PubMed  CrossRef  Google Scholar 

  26. Lynn P, Zagorodnyuk V, Hennig G et al (2005) Mechanical activation of rectal intraganglionic laminar endings in the guinea pig distal gut. J Physiol 564:589–601

    PubMed  CAS  CrossRef  Google Scholar 

  27. Hulsebosch CE, Coggeshall RE (1982) An analysis of the axon populations in the nerves to the pelvic viscera in the rat. J Comp Neurol 211:1–10

    PubMed  CAS  CrossRef  Google Scholar 

  28. Denny-Brown D, Robertson E (1935) An investigation of the nervous control of defaecation. Brain 58:256–310

    CrossRef  Google Scholar 

  29. Goligher JC, Hughes ESR (1951) Sensibility of rectum and colon: its role in the mechanism of anal continence. Lancet 1:543–548

    PubMed  CAS  CrossRef  Google Scholar 

  30. Ness TJ, Gebhart GF (1990) Visceral pain: a review of experimental studies. Pain 41:167–234

    PubMed  CAS  CrossRef  Google Scholar 

  31. Morgan C, Nadelhaft I, de Groat WC (1981) The distribution of visceral primary afferents from the pelvic nerve to Lissauer’s tract and the spinal gray matter and its relationship to the sacral parasympathetic nucleus. J Comp Neurol 201:415–440

    PubMed  CAS  CrossRef  Google Scholar 

  32. Baron R, Janig W, McLachlan EM (1985) The afferent and sympathetic components of the lumbar spinal outflow to the colon and pelvic organs in the cat. III. The colonic nerves, incorporating an analysis of all components of the lumbar prevertebral outflow. J Comp Neurol 238:158–168

    PubMed  CAS  CrossRef  Google Scholar 

  33. Janig W, Morrison JFB (1986) Functional properties of spinal visceral afferents supplying abdominal and pelvic organs, with special emphasis on visceral nociception. In: Cervero F, Morrison JFB (eds) Progress in brain research. Visceral sensation. Elsevier, Amsterdam, pp 87–114

    Google Scholar 

  34. Blumberg H, Haupt P, Janig W et al (1983) Encoding of visceral noxious stimuli in the discharge patterns of visceral afferent fibres from the colon. Pflug Arch 398:33–40

    CAS  CrossRef  Google Scholar 

  35. Bahns E, Halsband U, Janig W (1987) Responses of sacral visceral afferents from the lower urinary tract, colon and anus to mechanical stimulation. Pflugers Arch 410:296–303

    PubMed  CAS  CrossRef  Google Scholar 

  36. Cervero F, Janig W (1992) Visceral nociceptors: a new world order? Trends Neurosci 15:374–378

    PubMed  CAS  CrossRef  Google Scholar 

  37. Mayer EA, Gebhart GF (1994) Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 107:271–293

    PubMed  CAS  Google Scholar 

  38. Frenckner B, Ihre T (1976) Influence of autonomic nerves on the internal and sphincter in man. Gut 17:306–312

    PubMed  CAS  CrossRef  Google Scholar 

  39. Penninckx F, Lestar B, Kerremans R (1992) The internal anal sphincter: mechanisms of control and its role in maintaining anal continence. Baillieres Clin Gastroenterol 6:193–214

    PubMed  CAS  CrossRef  Google Scholar 

  40. Horgan PG, O’Connell PR, Shinkwin CA et al (1989) Effect of anterior resection on anal sphincter function. Br J Surg 76:783–786

    PubMed  CAS  CrossRef  Google Scholar 

  41. Lubowski DZ, Nicholls RJ, Swash M et al (1987) Neural control of internal anal sphincter function. Br J Surg 74:668–670

    PubMed  CAS  CrossRef  Google Scholar 

  42. Carlstedt A, Nordgren S, Fasth S et al (1988) Sympathetic nervous influence on the internal anal sphincter and rectum in man. Int J Colorectal Dis 3:90–95

    PubMed  CAS  CrossRef  Google Scholar 

  43. Enck P, Eggers E, Koletzko S et al (1991) Spontaneous variation of anal “resting” pressure in healthy humans. Am J Physiol 261:G823–826

    PubMed  CAS  Google Scholar 

  44. Morera C, Nurko S (2003) Rectal manometry in patients with isolated sacral agenesis. J Pediatr Gastroenterol Nutr 37(l):47–52

    PubMed  CrossRef  Google Scholar 

  45. Stebbing JF, Brading AF, Mortensen NJ (1996) Nitric oxide and the rectoanal inhibitory reflex: retrograde neuronal tracing reveals a descending nitrergic rectoanal pathway in a guinea-pig model. Br J Surg 83:493–498

    PubMed  CAS  CrossRef  Google Scholar 

  46. Nurko S, Rattan S (1988) Role of vasoactive intestinal polypeptide in the internal anal sphincter relaxation of the opossum. J Clin Invest 81:1146–1153

    PubMed  CAS  CrossRef  Google Scholar 

  47. Biancani P, Walsh J, Behar J (1985) Vasoactive intestinal peptide: a neurotransmitter for relaxation of the rabbit internal anal sphincter. Gastroenterology 89:867–874

    PubMed  CAS  Google Scholar 

  48. Floyd W, Walls E (1953) Electromyography of the sphincter ani externus in man. J Physiol 122:599–609

    PubMed  CAS  Google Scholar 

  49. Taverner D, Smiddy FG (1959) An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Col Rectum 2:153–160

    CAS  CrossRef  Google Scholar 

  50. Melzak J, Porter NH (1964) Studies of the reflex activity of the external sphincter ani in spinal man. Paraplegia 1:277–296

    PubMed  CAS  Google Scholar 

  51. Krier J, Adams T, Meyer RA (1988) Physiological, morphological, and histochemical properties of cat external anal sphincter. Am J Physiol: Gastrointest Liver Physiol 255:G772–778

    CAS  Google Scholar 

  52. Bharucha AE, Fletcher JG, Scide B et al (2005) Phenotypic variation in functional disorders of defecation. Gastroenterology 128(5): 1199–1210

    PubMed  CrossRef  Google Scholar 

  53. Salducci J, Planche D, Naudy B (1982) Physiological role of the internal anal sphincter and the external anal sphincter during micturition. In: Wienbeck M (eds) Motility of the digestive tract. Raven, New York, pp 513–520

    Google Scholar 

  54. Bassotti G, Crowell MD, Whitehead WE (1993) Contractile activity of the human colon: lessons from 24 hour studies. Gut 34:129–133

    PubMed  CAS  CrossRef  Google Scholar 

  55. MacDonald A, Paterson PJ, Baxter JN et al (1993) Relationship between intra-abdominal and intrarectal pressure in the proctometrogram. Br J Surg 80:1070–1071

    PubMed  CAS  CrossRef  Google Scholar 

  56. Halpert A, Keck L, Drossman DA et al (2004) Rectal contractions are part of normal defecation. Gastroenterology 126:A–362

    Google Scholar 

  57. Heaton KW, Ghosh S, Braddon FE (1991) How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form. Gut 32:73–79

    PubMed  CAS  CrossRef  Google Scholar 

  58. Sapsford RR, Hodges PW, Richardson CA et al (2001) Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn 20:31–42

    PubMed  CAS  CrossRef  Google Scholar 

  59. Bharucha AE, Croak AJ, Gebhart JB et al (2006) Comparison of rectoanal axial forces in health and functional defecatory disorders. Am J Physiol: Gastro Liver Physiol 290: G1164–G1169

    CAS  CrossRef  Google Scholar 

  60. Miller R, Bartolo DC, Cervero F et al (1988) Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg 75:44–47

    PubMed  CAS  CrossRef  Google Scholar 

  61. Garry R (1933) The responses to stimulation of the caudal end of the large bowel in the cat. J Physiol Lond 78:208

    PubMed  CAS  Google Scholar 

  62. Parks AG, Fishlock DJ, Cameron JD et al (1969) Preliminary investigation of the pharmacology of the human internal anal sphincter. Gut 10:674–677

    PubMed  CAS  CrossRef  Google Scholar 

  63. Madoff RD, Fleshman JW (2003) AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology 124:235–245

    PubMed  CrossRef  Google Scholar 

  64. Read M, Read NW, Barber DC et al (1982) Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 27:807–814

    PubMed  CAS  CrossRef  Google Scholar 

  65. Cheetham MJ, Kamm MA, Phillips RK (2001) Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut 48:356–359

    PubMed  CAS  CrossRef  Google Scholar 

  66. Carapeti EA, Kamm MA, Phillips RK (2000) Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence. Br J Surg 87:38–42

    PubMed  CAS  CrossRef  Google Scholar 

  67. Koda K, Saito N, Scike K et al (2005) Denervation of the neorectum as a potential cause of defecatory disorder following low anterior resection for rectal cancer. Dis Colon Rectum 48:210–217

    PubMed  CrossRef  Google Scholar 

  68. Batignani G, Monaci I, Ficari F et al (1991) What affects continence after anterior resection of the rectum? Dis Colon Rectum 34:329–335

    PubMed  CAS  CrossRef  Google Scholar 

  69. Williamson ME, Lewis WG, Finan PJ et al (1995) Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? Dis Colon Rectum 38:411–418

    PubMed  CAS  CrossRef  Google Scholar 

  70. Devroede G, Lamarche J (1974) Functional importance of extrinsic parasympathetic innervation to the distal colon and rectum in man. Gastroenterology 66:273–280

    PubMed  CAS  Google Scholar 

  71. Scott HWJ, Cantrell JR (1949) Colonmetrographic studies of the effects of section of the parasympathetic nerves of the colon. Bull Johns Hopkins Hosp 85:310–319

    PubMed  Google Scholar 

  72. Lindsey I, Guy RJ, Warren BF et al (2000) Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 87:1288–1299

    PubMed  CAS  CrossRef  Google Scholar 

  73. Bharucha AE (2003) Fecal incontinence. Gastroenterology 124:1672–1685

    PubMed  CrossRef  Google Scholar 

  74. Mostwin J BA, Haab F, Koelbl H et al (2005) Pathophysiology of urinary incontinence, fecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L et al (eds) Incontinence. Health Publication, Paris, pp 425–484

    Google Scholar 

  75. Sultan AH (1999) Obstetrical perineal injury and anal incontinence. Clin Risk 5:193–196

    Google Scholar 

  76. Sultan AH, Kamm MA, Hudson CN et al (1993) Analsphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911

    PubMed  CAS  CrossRef  Google Scholar 

  77. Carroli G, Belizan J (2006) Episiotomy for vaginal birth [systematic review]. Cochrane Database of Systematic Reviews http://www.cochrane.org. Cited 15 Nov 2006

  78. Royal College of Obstetricians and Gynaecologists (2001) Management of third-and fourth-degree perineal tears following vaginal deliveries. London

    Google Scholar 

  79. Fernando RJ, Sultan AH, Kettle C et al (2006) Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial. Obstet Gynecol 107:1261–1268

    PubMed  Google Scholar 

  80. Sultan AH, Monga AK, Kumar D et al (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 106:318–323

    PubMed  CAS  Google Scholar 

  81. Norderval S, Oian P, Revhaug A et al (2005) Anal incontinence after obstetric sphincter tears: outcome of anatomic primary repairs. Dis Colon Rectum 48:1055–1061

    PubMed  CrossRef  Google Scholar 

References

  1. Salvioli B, Bharucha AE, Rath-Harvey D et al (2001) Rectal compliance, capacity, and rectoanal sensation in fecal incontinence. Am J Gastroenterol 96:2158–2168

    PubMed  CAS  CrossRef  Google Scholar 

  2. Bharucha AE, Fletcher JG, Harper CM et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut 54:546–555

    PubMed  CAS  CrossRef  Google Scholar 

  3. Andrews C, Bharucha AE, Scide B et al (2007) Rectal sensorimotor dysfunction in women with fecal incontinence. Am J Physiol Gastrointest Liver Physiol 292:G282–G289

    PubMed  CAS  CrossRef  Google Scholar 

  4. Williams NS, Ogunbiyi OA, Scott SM et al (2001) Rectal augmentation and stimulated gracilis anal neosphincter: a new approach in the management of fecal urgency and incontinence. Dis Colon Rectum 44:192–198

    PubMed  CAS  CrossRef  Google Scholar 

  5. Chan CL, Scott SM, Williams NS et al (2005) Rectal hypersensitivity worsens stool frequency, urgency, and lifestyle in patients with urge fecal incontinence. Dis Colon Rectum 48:134–140

    PubMed  CrossRef  Google Scholar 

  6. Chan CL, Lunniss PJ, Wang D (2005) Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies. Gut 54:1263–1272

    PubMed  CAS  CrossRef  Google Scholar 

  7. Sun WM, Donnelly TC, Read NW (1992) Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of idiopathic faecal incontinence. Gut 33:807–813

    PubMed  CAS  CrossRef  Google Scholar 

  8. Siproudhis L, El Abkari M, El Alaoui M et al (2005) Low rectal volumes in patients suffering from fecal incontinence: what does it mean? Aliment Pharmacol Ther 22:989–996

    PubMed  CAS  CrossRef  Google Scholar 

  9. Hoffmann BA, Timmcke AE, Gathright JB Jr et al (1995) Fecal seepage and soiling: a problem of rectal sensation. Dis Colon Rectum; 38:746–748

    PubMed  CAS  CrossRef  Google Scholar 

  10. Siproudhis L, Bellissant E, Juguet F et al (1999) Perception of and adaptation to rectal isobaric distension in patients with faecal incontinence. Gut 44:687–692

    PubMed  CAS  CrossRef  Google Scholar 

  11. Gladman MA, Scott SM, Chan CL et al (2003) Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence. Dis Colon Rectum 46:238–246

    PubMed  CrossRef  Google Scholar 

  12. Rao SS, Ozturk R, Stessman M (2004) Investigation of the pathophysiology of fecal seepage. Am J Gastroenterol 99:2204–2209

    PubMed  CrossRef  Google Scholar 

  13. Gladman MA, Dvorkin LS, Lunniss PJ et al (2005) Rectal hyposensitivity: a disorder of the rectal wall or the afferent pathway? An assessment using the barostat. Am J Gastroenterol 100:106–114

    PubMed  CrossRef  Google Scholar 

  14. Gladman MA, Lunniss PJ, Scott SM et al (2006) Rectal hyposensitivity. Am J Gastroenterol 101:1140–1151

    PubMed  CrossRef  Google Scholar 

  15. Bampton PA, Dinning PG, Kennedy ML et al (2001) Prolonged multi-point recording of colonic manometry in the unprepared human colon: providing insight into potentially relevant pressure wave parameters. Am J Gastroenterol 96:1838–1848

    PubMed  CAS  CrossRef  Google Scholar 

  16. Scott SM (2003) Manometric techniques for the evaluation of colonic motor activity: current status. Neurogastroenterol Motil 15:483–513

    PubMed  CAS  CrossRef  Google Scholar 

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

    PubMed  CAS  CrossRef  Google Scholar 

  18. Rao SS, Sadeghi P, Beaty J et al (2001) Ambulatory 24-h colonie manometry in healthy humans. Am J Physiol Gastrointest Liver Physiol 280:G629–G639

    PubMed  CAS  Google Scholar 

  19. Sarosiek I, Majewski M, The SmartPill Trial Group et al (2006) Non-digestible capsule (SmartPill) as a novel diagnostic tool for detecting motility impairment within the gut. Neurogastroenterol Motil 18:786 (Abstract)

    Google Scholar 

  20. Turnbull GK, Hamdy S, Aziz Q et al (1999) The cortical topography of human anorectal musculature. Gastroenterology 117:32–39

    PubMed  CAS  CrossRef  Google Scholar 

  21. Sheldon R, Kiff ES, Clarke A et al (2005) Sacral nerve Stimulation reduces corticoanal excitability in patients with faecal incontinence. Br J Surg 92:1423–1431

    PubMed  CAS  CrossRef  Google Scholar 

  22. Harris ML, Hobson AR, Hamdy S et al (2006) Neurophysiological evaluation of healthy human anorectal sensation. Am J Physiol Gastrointest Liver Physiol 291:G950–G958

    PubMed  CAS  CrossRef  Google Scholar 

  23. Thompson DG (2006) Neurogastroenterology: imaging of the sensory and motor control of the GI tract. J Psychosom Res 61:301–304

    PubMed  CrossRef  Google Scholar 

  24. Mayer EA, Naliboff BD, Craig AD et al (2006) Neuroimaging of the brain-gut axis: from basic understanding to treatment of functional GI disorders. Gastroenterology 131:1925–1942

    PubMed  CrossRef  Google Scholar 

  25. Fernandez-Fraga X, Azpiroz F, Malagelada JR (2002) Significance of pelvic floor muscles in anal incontinence. Gastroenterology 123:1441–1450

    PubMed  CrossRef  Google Scholar 

  26. Eguare EI, Neary P, Crosbie J et al (2004) Dynamic magnetic resonance imaging of the pelvic floor in patients with idiopathic combined fecal and urinary incontinence. J Gastrointest Surg 8:73–82

    PubMed  CrossRef  Google Scholar 

  27. Gladman MA, Williams NS, Scott SM et al (2005) Medium-term results of vertical reduction rectoplasty and sigmoid colectomy for idiopathic megarectum. Br J Surg 92:624–630

    PubMed  CAS  CrossRef  Google Scholar 

  28. Dinning PG, Fuentealba SE, Kennedy ML et al (2007) Sacral nerve stimulation induces pan-colonic propagating pressure waves and increases defecation frequency in patients with slow-transit constipation. Colorectal Dis 9:123–132

    PubMed  CAS  CrossRef  Google Scholar 

  29. Gourcerol G, Gallas S, Michot F et al (2007) Sacral nerve stimulation in fecal incontinence: are there factors associated with success? Dis Colon Rectum 50:3–12

    PubMed  CrossRef  Google Scholar 

  30. Michelsen HB, Buntzen S, Krogh K et al (2006) Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation. Dis Colon Rectum 49:1039–1044

    PubMed  CrossRef  Google Scholar 

  31. Jarrett ME, Mowatt G, Glazener CM et al (2004) Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559–1569

    PubMed  CAS  CrossRef  Google Scholar 

  32. Uludag O, Morren GL, Dejong CH et al (2005) Effect of sacral neuromodulation on the rectum. Br J Surg 92:1017–1023

    PubMed  CAS  CrossRef  Google Scholar 

  33. Duthie HL, Gairns FW (1960) Sensory nerve endings and sensation in the anal region of man. Br J Surg 47:585–595

    PubMed  CAS  CrossRef  Google Scholar 

  34. Felt-Bersma RJ, Poen AC, Cuesta MA et al (1997) Anal sensitivity test: what does it measure and do we need it? Cause or derivative of anorectal complaints. Dis Colon Rectum 40:811–816

    PubMed  CAS  CrossRef  Google Scholar 

  35. Lunniss PJ, Phillips RK (1992) Anatomy and function of the anal longitudinal muscle. Br J Surg 79:882–884

    PubMed  CAS  CrossRef  Google Scholar 

  36. O’Kelly TJ, Brading A, Mortensen NJ (1993) In vitro response of the human anal canal longitudinal muscle layer to cholinergic and adrenergic stimulation: evidence of sphincter specialization. Br J Surg 80:1337–1341

    PubMed  CAS  CrossRef  Google Scholar 

  37. Shafik A (1976) A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. III. The longitudinal anal muscle: anatomy and role in anal sphincter mechanism. Invest Urol 13:271–277

    PubMed  CAS  Google Scholar 

  38. Haas PA, Fox TAJr, Haas GP (1984) The pathogenesis of hemorrhoids. Dis Colon Rectum 27:442–450

    PubMed  CAS  CrossRef  Google Scholar 

  39. Burleigh DE (1983) Non-cholinergic, non-adrenergic inhibitory neurons in human internal anal sphincter muscle. J Pharm Pharmacol 35:258–260

    PubMed  CAS  Google Scholar 

  40. Cook TA, Brading AF, Mortensen NJMcC (1999) Differences in contractile properties of anorectal smooth muscle and the effects of calcium channel blockade. Br J Surg 86:70–75

    PubMed  CAS  CrossRef  Google Scholar 

  41. Loder PB, Kamm MA, Nicholls RJ et al (1994) ‘Reversible chemical sphincterotomy’ by local application of glyceryl trinitrate. Br J Surg 81:1386–1389

    PubMed  CAS  CrossRef  Google Scholar 

  42. Carapeti EA, Kamm MA, Phillips RK (2000) Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence. Br J Surg 2000 87:38–42

    PubMed  CAS  CrossRef  Google Scholar 

  43. Sangwan YP, Coller JA, Schoetz DJ et al (1996) Spectrum of abnormal rectoanal reflex patterns in patients with fecal incontinence. Dis Colon Rectum 39:59–65

    PubMed  CAS  CrossRef  Google Scholar 

  44. Zbar AP, Aslam M, Gold DM et al (1998) Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation. Dis Colon Rectum 41:200–208

    PubMed  CAS  CrossRef  Google Scholar 

  45. Kaur G, Gardiner A, Duthie GS (2002) Rectoanal reflex parameters in incontinence and constipation. Dis Colon Rectum 45:928–933

    PubMed  CrossRef  Google Scholar 

  46. Akervall S, Fasth S, Nordgren S et al (1989) Rectal reservoir and sensory function studied by graded isobaric distension in normal man. Gut 30:496–502

    PubMed  CAS  CrossRef  Google Scholar 

  47. Sun WM, Read NW, Prior A et al (1990) Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation. Gastroenterology 99:1008–1015

    PubMed  CAS  Google Scholar 

  48. Corsetti M, Cesana B, Bhoori S (2004) Rectal hyperreactivity to distention in patients with irritable bowel syndrome: role of distention rate. Clin Gastroenterol Hepatol 2:49–56

    PubMed  CrossRef  Google Scholar 

  49. Shafik A, el Sherif M, Youssef A et al (1995) Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 8:110–115

    PubMed  CAS  CrossRef  Google Scholar 

  50. Schraffordt SE, Tjandra JJ, Eizenberg N et al (2004) Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg 74:23–26

    PubMed  CrossRef  Google Scholar 

  51. Enck P, Hinninghofen H, Wietek B et al (2004) Functional asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence. Digestion 69:102–111

    PubMed  CrossRef  Google Scholar 

  52. Hamdy S, Enck P, Aziz Q et al (1999) Laterality effects of human pudendal nerve stimulation on corticoanal pathways: evidence for functional asymmetry. Gut 45:58–63

    PubMed  CAS  CrossRef  Google Scholar 

  53. Enck P, Hinninghofen H, Merletti R et al (2005) The external anal sphincter and the role of surface electromyography. Neurogastroenterol Motil 17(Suppl 1): 60–67

    PubMed  CrossRef  Google Scholar 

  54. Gooneratne ML, Scott SM, Lunniss PJ (2007) Unilateral pudendal neuropathy is common in patients with fecal incontinence. Dis Colon Rectum (in press)

    Google Scholar 

  55. Lynn PA, Olsson C, Zagorodnyuk V et al (2003) Rectal intraganglionic laminar endings are transduction sites of extrinsic mechanoreceptors in the guinea pig rectum. Gastroenterology 125:786–794

    PubMed  CrossRef  Google Scholar 

  56. Chan CL, Facer P, Davis JB et al (2003) Sensory fibres expressing capsaicin receptor TRPV1 in patients with rectal hypersensitivity and faecal urgency. Lancet 361:385–391

    PubMed  CAS  CrossRef  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2007 Springer-Verlag Italia

About this chapter

Cite this chapter

Bharucha, A.E., Blandon, R.E., Lunniss, P.J., Scott, S.M. (2007). Anatomy and Physiology of Continence. In: Ratto, C., Doglietto, G.B., Lowry, A.C., Påhlman, L., Romano, G. (eds) Fecal Incontinence. Springer, Milano. https://doi.org/10.1007/978-88-470-0638-6_1

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0638-6_1

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0637-9

  • Online ISBN: 978-88-470-0638-6

  • eBook Packages: MedicineMedicine (R0)