anorectal anatomy and physiology surgical anal canal ≈ 5 cm up to the anorectal ring anatomic anal...
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Anorectal anatomy and physiology
Surgical anal canal ≈ 5 cm up to the Anorectal ring
Anatomic anal canal ≈ 3 cm up to the dentate line
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The rectum
1/3 division Peritoneal coverage Valves of Houston Anorectal angle Fascial attachments; lateral ligament,
Denonvillier fascia, rectosacral fascia
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Anorectal anatomy and physiology
Dentate line (pectinate) Anoderm Transitional area Columns of Morgagni Internal hemmorrhoidal plexus
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Anorectal anatomy and physiology
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Anatomy of the anal canal
Anal glands Anal sphincters Levator ani Anococcygeal raphi Perianal spaces
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External sphincter
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Levator ani
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Anorectal angle
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Perianal & perirectal spaces
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Blood supply of the anorectum
Portal circulation; inferior mesenteric artery → superior rectal artery
Systemic circulation; middle rectal artery, inferior rectal artery, middle sacral artery
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Blood supply
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Venous drainage
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Lymphatic drainage of anus& rectum
Perirectal nodes Inferior mesenteric nodes Internal iliac nodes Superficial inguinal nodes
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Lymphatic drainage of rectum
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Lymphatic drainage of anus
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Nerve supply of the rectum
Sympathetic L1-3 Parasympathetic S2-4 (nervi ergentes) The hypogastric plexus Pelvic plexus
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Nerve supply of the anus
Pudendal nerve (S2-4) Sensory; internal pudendal Motor
Internal sphincter; sympathetic & parasympathetic External sphincter; inferior rectal branch of internal
pudendal n, perineal branch of S4
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Nerve supply
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Physiology of defecation
Reflex Sensation; receptive relaxation of the rectum,
anal sampling, rectoanal reflex Center; S2-4, cortical Effectors; sphincters, rectal contraction,
abdominal muscles, levator
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Physiology of defecation
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Continence mechanism
Sensory function; proprioception, touch Rectal reservoir function Internal sphincter; involuntary, resting tone External sphincter; voluntary, squeeze
pressure Levator ani Anorectal angle Anal cushions
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Anal incontinencetypes
Major; solid feces Minor; gas, liquid stools, night soiling
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Anal incontinenceCauses
Structural damage; Rectal disease Sphincter injury; birth trauma , surgery ….
Neurologic ; Idiopathic
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Anal incontinencediagnosis
History Rectal examination; tone, squeeze pressure ,
soilage, …. Endoscopy Endoanal U/S Manometry Nerve studies
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Endoanal Ultrasonography
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Anal incontinenceTreatment
Diet and drugs Biofeedback Sphincteroplasty Gracilis flap ± electrical stimulator Sacral nerve stimulation= neuromodulation Artificial anal sphincter colostomy
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Sphincteroplasty
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Artificial anal sphincter