The relationship between perineal descent and denervation of the puborectalis in continent patients
Tóm tắt
It has been suggested that perineal descent causes puborectalis neuropathy. To elucidate this, perineal descent was measured on standard proctograms and prolongation of mean motor unit potential duration was used as the index of denervation of the external sphincter and puborectalis in 9 male and 18 female patients with perineal descent and obstructed defaecation. The findings were compared with 21 normal controls. There was no significant perineal descent below the pubococcygeal line at rest but both males and females had abnormal descent of the anorectal angle on straining and a similar degree of external sphincter neuropathy. Females, however, exhibited a significant degree of puborectalis denervation compared with controls (p<0.001) and with male patients (p<0.001). Thus external sphincter denervation was associated with perineal descent in both sexes whereas other causes, of which obstetric trauma is a possibility, must be implicated in the puborectalis neuropathy of the females studied.
Tài liệu tham khảo
Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18:656–665
Beersiek, Parks AG, Swash M (1979) Pathogenesis of anorectal incontinence: a histometric study of the anal canal musculature. J Neurol Sci 42:111–127
Henry MM, Parks AG, Swash M (1980) An electrophysiological study of the anal reflex in patients with idiopathic faecal incontinence. Br J Surg 67:781–783
Neill ME, Swash M (1980) Increased motor unit fibre density in the external anal sphincter in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 43:343–347
Neill ME, Parks AG, Swash M (1981) Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse. Br J Surg 68:531–536
Henry MM, Parks AG, Swash M (1983) The pelvic floor musculature in the descending perineum syndrome. Br J Surg 69:470–472
Henry MM, Swash M (1978) Assessment of pelvic floor disorders and incontinence by electrophysiological recording of the anal reflex. Lancet 1:1290–1291
Parks AG, Swash M (1979) Denervation of the anal sphincter causing idiopathic faecal incontinence. J Roy Coll Surg Edinburgh 24:94–96
Parks AG (1975) Anorectal incontinence. Proc Roy Soc Med 68:681–690
Bartolo DCC, Jarratt JA, Read NW (1983) The use of conventional electromyography to assess external anal sphincter neuropathy in man. J Neurol Neurosurg Psychiatry 46:115–118
Bartolo DCC, Jarratt JA, Read NW (1983) The cutaneo-anal reflex: a useful index of neuropathy? Br J Surg 70:660–663
Bartolo DCC, Read NW, Jarratt JA, Read MG, Donnelly TC, Johnson AG (1983) Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent. Gastroenterology 85:68–75
Bartolo DCC, Jarratt JA, Read MG, Donnelly TC, Read NW (1983) The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg 70:664–667
Read NW, Bartolo DCC, Read MG (1984) Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 71:39–42
Snooks SJ, Barnes PRH, Swash M (1984) Damage to the voluntary anal and urinary sphincter musculature in incontinence. J Neurol Neurosurg Psychiatry 47:1269–1273
Snooks SJ, Henry MM, Swash M (1985) Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles. Gut 26:470–476
Swash M (1985) Idiopathic faecal incontinence: histopathological evidence on pathogenesis. In: Wright R (ed) Recent advances in gastrointestinal pathology. Saunders, London pp 71–89
Parks AG, Porter NH, Hardcastle J (1966) The syndrome of the descending perineum. Proc Roy Soc Med 59:477–482
Kiff ES, Swash M (1984) Slowed conduction in the pudendal nerve in idiopathic (neurogenic) faecal incontinence. Br J Surg 71:614–616
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
Kiff ES, Barnes PRH, Swash M (1984) Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool. Gut 25:1279–1282
Snooks SJ, Setchell M, Swash M, Henry MM (1984) Injury to the innervation of the pelvic floor musculature in childbirth. Lancet 2:546–550
Bartolo DCC, Roe AM, Virjee J, Mortensen NJMcC (1985) Evacuation proctqgraphy in obstructed defaecation and rectal intussusception. Br J Surg Suppl; S111–116
Percy JP, Neill ME, Swash M, Parks AG (1981) Electrophysiological study of motor nerve supply of pelvic floor. Lancet 1:16–17
Lawson JON (1974) Pelvic anatomy. II Anal canal and associated sphincters. Ann R Coll Surg Engl 54:288–300
Morgan CN (1949) The surgical anatomy of the ischio-rectal space. Proc R Soc Med 42:189–200
Kerremans R (1969) Morphological and physiological aspects of anal continence and defaecation. Editions Arscia SA, Brussels
Duthie HL (1978) Anal continence. Gut 12:844–852
Dickinson VA (1978) Maintenance of anal continence: a review of pelvic floor physiology. Gut 19:1163–1174
Harris LD, Pope CE (1984) Squeeze vs resistance: an evaluation of the mechanism of sphincter competance. J Clin Invest 43:2272–2278
Duthie HL, Watts JM (1965) Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 6:64–68
Freckner B, von Euler C (1975) Influence of pudendal block on the function of the anal sphincters. Gut 16:482–489
Read NW, Bannister JJ (1985) Anorectal manometry: Techniques in health and disease. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Pathophysiology and management. Butterworths, London
Womack NR, Morrison JFB, Williams NS (1985) The influence of perineal descent in ideopathic faecal incontinence. Br J Surg 72:403