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Related Experiment Videos

Neural control of internal anal sphincter function.

D Z Lubowski1, R J Nicholls, M Swash

  • 1St. Mark's Hospital, London, UK.

The British Journal of Surgery
|August 1, 1987
PubMed
Summary

Electrical stimulation of presacral sympathetic nerves significantly reduces anal pressure by relaxing the internal anal sphincter. This study also identified a local intramural pathway for the recto-anal reflex.

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Area of Science:

  • Gastroenterology
  • Neuroscience
  • Surgical Physiology

Background:

  • The role of the autonomic nervous system in regulating anal tone is complex.
  • Understanding the neural pathways controlling the internal anal sphincter is crucial for surgical interventions and managing anorectal disorders.

Purpose of the Study:

  • To investigate the effect of electrical stimulation of presacral sympathetic nerves on anal tone.
  • To elucidate the pathway of the recto-anal reflex.

Main Methods:

  • Electrical stimulation of presacral (hypogastric) sympathetic nerves in eight patients undergoing abdominal rectopexy or restorative proctocolectomy.
  • Measurement of anal pressure changes.
  • Intra-operative study of the recto-anal reflex pathway in three patients undergoing rectal excision, including presacral nerve blockade and rectal myotomy.

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Main Results:

  • Electrical stimulation of presacral sympathetic nerves caused a significant fall in anal pressure in seven out of eight patients (mean fall 59 cmH2O).
  • The effect was attenuated by labetalol, a beta- and alpha-sympathetic blocking drug.
  • The recto-anal reflex was found to have a local intramural pathway, persisting after presacral nerve blockade but abolished by rectal myotomy.

Conclusions:

  • Presacral sympathetic nerve stimulation induces relaxation of the internal anal sphincter.
  • The recto-anal reflex operates via a local intramural pathway, supporting its role in conditions like Hirschsprung's disease.