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Anorectal anatomy and physiology

Anorectal anatomy and physiology. Surgical anal canal ≈ 5 cm up to the Anorectal ring Anatomic anal canal ≈ 3 cm up to the dentate line. The rectum. 1/3 division Peritoneal coverage Valves of Houston Anorectal angle

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Anorectal anatomy and physiology

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  1. Anorectal anatomy and physiology • Surgical anal canal ≈ 5 cm up to the Anorectal ring • Anatomic anal canal ≈ 3 cm up to the dentate line

  2. The rectum • 1/3 division • Peritoneal coverage • Valves of Houston • Anorectal angle • Fascial attachments; lateral ligament, Denonvillier fascia, rectosacral fascia

  3. Anorectal anatomy and physiology • Dentate line (pectinate) • Anoderm • Transitional area • Columns of Morgagni • Internal hemmorrhoidal plexus

  4. Anorectal anatomy and physiology

  5. Anatomy of the anal canal • Anal glands • Anal sphincters • Levator ani • Anococcygeal raphi • Perianal spaces

  6. External sphincter

  7. Levator ani

  8. Anorectal angle

  9. Perianal & perirectal spaces

  10. Blood supply of the anorectum • Portal circulation; inferior mesenteric artery → superior rectal artery • Systemic circulation; middle rectal artery, inferior rectal artery, middle sacral artery

  11. Blood supply

  12. Venous drainage

  13. Lymphatic drainage of anus& rectum • Perirectal nodes • Inferior mesenteric nodes • Internal iliac nodes • Superficial inguinal nodes

  14. Lymphatic drainage of rectum

  15. Lymphatic drainage of anus

  16. Nerve supply of the rectum • Sympathetic L1-3 • Parasympathetic S2-4 (nervi ergentes) • The hypogastric plexus • Pelvic plexus

  17. 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

  18. Nerve supply

  19. 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

  20. Physiology of defecation

  21. 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

  22. Anal incontinencetypes • Major; solid feces • Minor; gas, liquid stools, night soiling

  23. Anal incontinenceCauses • Structural damage; • Rectal disease • Sphincter injury; birth trauma , surgery …. • Neurologic ; • Idiopathic

  24. Anal incontinencediagnosis • History • Rectal examination; tone, squeeze pressure , soilage, …. • Endoscopy • Endoanal U/S • Manometry • Nerve studies

  25. Endoanal Ultrasonography

  26. Anal incontinenceTreatment • Diet and drugs • Biofeedback • Sphincteroplasty • Gracilis flap ± electrical stimulator • Sacral nerve stimulation= neuromodulation • Artificial anal sphincter • colostomy

  27. Sphincteroplasty

  28. Artificial anal sphincter

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