Neuropeptides in the internal anal sphincter in neurogenic faecal incontinence

The internal anal sphincter has both an intrinsic and extrinsic innervation which modulates its activity. While the nature of the extrinsic innervation has been well characterised, the same is not true of the intrinsic innervation. Although a variety of neurotransmitters have been identified in the human internal anal sphincter, their physiological role in health, and possible involvement in disease processes, have received little attention. Using immunohistochemistry we have studied the distribution and nerve fibre densities of a range of neuropeptides in the internal anal sphincter from 12 cancer patients (controls) and from 16 patients with neurogenic faecal incontinence. We have also studied the in vitro effect of vasoactive intestinal peptide, neuropeptide tyrosine, and galanin on isolated preparations of the internal anal sphincter from 11 cancer controls and 5 patients with neurogenic faecal incontinence. There was no difference in either the distribution or density of the neuropeptides between the 2 groups of patients, and there was no qualitative difference in the in vitro responses of the sphincter to the neuropeptides. These findings suggest that these neuropeptide components of the intrinsic innervation of the internal anal sphincter are unaffected in patients with neurogenic faecal incontinence.