Spastic contraction of internal anal sphincter
Introduction
Introduction to anal canal sphincter spasm Anal canal sphincter contraction (spasmodic contractionofandsphincter) also known as anal canal sphincter achalasia. Under normal circumstances, the expansion of the rectal or rectosigmoid colon can immediately cause reflex relaxation of the anal canal sphincter (IAS). This reflex is called the rectal sphincter. Relaxation, or rectal inhibition, is important for bowel movements. If the IAS is incapable of relaxation, it will lead to obstructive constipation at the exit. basic knowledge The proportion of sickness: 0.2% Susceptible people: no specific population Mode of infection: non-infectious Complications: abdominal pain, metabolic alkalosis
Cause
Anal canal sphincter spasm
(1) Causes of the disease
1. Absence of ganglion cells in the intestinal wall: such as rectal weakness, supporting nerve abnormalities in the anal canal sphincter, is a special type of ultrashort megacolon.
2. Long-term neglect of the intention: when the amount of feces in the rectum reaches a certain amount to increase the internal pressure, it will produce a sense of intention, which means a sense of proprioception and organ sensation produced by the nervous system in the cerebral cortex when the rectum is inflated, if neglected It is convenient to contract the external sphincter, which in turn stimulates the contraction of the internal sphincter. The reflex causes the rectal wall to relax, the internal pressure drops, and the long-term neglect of the intention makes this reflex become a habit, which leads to the internal sphincter spasm.
3. Organic changes: long-term spasmodic contraction of the internal sphincter of the anal canal can also lead to hypertrophic degeneration, that is, functional changes translate into organic changes.
(two) pathogenesis
Currently there are no related content description.
Prevention
Anal canal sphincter spasm prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Anal canal sphincter spasm contraction complications Complications abdominal pain metabolic alkalosis
The disease is mainly caused by the gastrointestinal stenosis caused by the corresponding gastrointestinal tract complication. Such as when severe constipation occurs, it can produce a series of symptoms such as abdominal distension, abdominal pain, nausea and vomiting and defecation disorder. In severe cases, blood supply to the intestinal wall can be caused, followed by intestinal necrosis. If not treated actively, it can lead to death. Patients with severe vomiting may suffer from metabolic alkalosis due to large amounts of gastric fluid loss, so blood gas analysis and electrolytes should be monitored dynamically to prevent electrolyte imbalance and acid-base metabolism imbalance caused by excessive vomiting.
Symptom
Anal canal sphincter spasm contraction symptoms common symptoms fecal impaction
Mainly for painless defecation, easy to be indifferent or inconvenient, dry stool, some patients have perineal soreness and discomfort, anal rectal examination, internal sphincter elasticity is enhanced, there may be tenderness, anal canal pressure is increased, and even fingertips enter The anal canal is very difficult, and there is more feces in the rectum.
Examine
Anal canal sphincter spasm
1. Defecation angiography: Observable:
1 The anal canal is not open, the rectal neck is symmetrically saclike, and the radish is changed at the junction of the anorectal and rectum;
2 resting at the rectum, the rectum is obvious, and even the giant rectum appears;
3 sputum can not be completely emptied.
2. Determination of anorectal pressure: The resting pressure of the anal canal is mainly maintained by the internal sphincter. Therefore, the resting pressure of the patient is significantly higher than normal. In addition, the amplitude of the IAS relaxation is decreased or cannot be elicited, which is positive for the diagnosis. When the balloon expands the rectum, the anal canal pressure does not decrease or rises.
3. The maximum tolerance of the rectum is significantly increased.
4. Pelvic EMG: The discharge frequency and discharge interval of the internal sphincter EMG, and the presence or absence of electrical rhythm inhibition during the expansion of the rectum are important for the diagnosis of this disease and the identification of other outlet obstructive constipation.
Diagnosis
Diagnosis and differentiation of anal canal sphincter spasm
diagnosis
Anal canal sphincter spasm is an anorectal dysfunction disorder, which is not uncommon in clinical practice. According to clinical symptoms and digital rectal examination, the diagnosis of this disease is not difficult.
Differential diagnosis
Should be differentiated from puborectal syndrome, the internal sphincter elasticity is enhanced, the anal canal pressure is high, and even the fingertips are difficult to enter the anal canal. When the puborectalis syndrome is diagnosed, the internal sphincter is loose and can enter. Anal canal, but only narrow or hypertrophic in the puborectal muscle segment.
