By Richard Cohen, Alastair Windsor
There is a rise in specialisation inside of common surgical procedure and now even inside its sub specialties. Colorectal surgical procedure is likely one of the greatest of the subspecialties of basic surgical procedure, and one of many components the place trainees and advisor common /colorectal surgeons are least convinced is of their knowing of the anatomy, physiological pathology and administration of the anal canal and pelvis.
Currently on hand there are books out there concentrated round the basic administration of colorectal sickness, however the time is now correct for a definitive textual content at the anal canal and pelvis in particular.
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Extra resources for Anus: Surgical Treatment and Pathology
There is also debate on whether puborectalis contraction is in response to the absence of stool passing through the anal canal rather than a cause of the constipation. Certainly deferring defaecation has been shown to slow colonic transit in normal individuals, establishing colonic transit and rectal evacuation as inextricably linked . Despite the controversy surrounding the functional significance of anismus, it has firmly established itself as a diagnosis in patients with obstructive defaecation syndrome.
Physiology of Rectal Sensation In contrast to the anal canal, Duthie and Gairns when studying the rectum found no free nerve endings and few or no organised nerve endings resulting in a poor sensitivity to pain, touch and temperature. Goligher et al. described the ability to detect balloon distension in the colon and rectum . Distension in the colon results in a sensation of discomfort in the lower abdomen in contrast to distension of the rectum which results in a sensation of flatus or the desire to defaecate.
2 Anorectal Physiology Attempted Defaecation and Balloon Expulsion Patients with symptoms of prolapse and elderly patients with a history of constipation who present with passive incontinence should be thoroughly examined for the presence of a full-thickness rectal prolapse. They should be asked to strain as heavily as they would to pass stools whilst on a toilet or commode and given enough time to reproduce the prolapsing lump before examination. Expulsion of a 60 ml water-filled balloon on a commode or toilet can be used in the assessment of constipated patients.