Anal relaxation
Introduction
Introduction Anal relaxation, contraction of the anal canal sphincter and anorectal ring contraction is not obvious and completely disappeared, if caused by injury, the anus can be scarred and scar tissue, incomplete incontinence can be diagnosed and the sphincter contractility is weakened. Common in anal incontinence. Complete incontinence, common anus opening is round, or deformed, defect, scar, excretion of feces, intestinal fluid, anal skin may have eczema-like changes. Retracting the buttocks by hand, the anal canal is completely relaxed and round, and sometimes the anal canal is partially deficient. Scar formation is often seen from the round hole. Incomplete incontinence does not close the anus, and there is fecal contamination in the anus when diarrhea occurs.
Cause
Cause
1 anorectal colon disease: the most common for rectal tumors and inflammatory diseases, rectal tumor infiltration damage sphincter, ulcerative colitis, colonic disease caused by long-term diarrhea of rectal inflammation, complete rectal prolapse caused by anal relaxation, pudendal nerve traction Loss and so on.
2 Trauma is mainly sphincter injury: the most common cause is anorectal surgery and birth injury, especially high anal fistula surgery destroys the anorectal and sphincter, and the third degree of perineal tear in the birth injury. In addition, internal hemorrhoids, anal fissures, rectal prolapse, rectal tumors and other surgical treatments are improper, or the anal canal tissue suffers from external violence, drug injection, burns, frostbite, etc. can cause anal incontinence.
3 neurological diseases: such as central nervous system diseases, spina bifida, spinal meningocele, spinal cord and radial nerve injury, infection and myeloma.
4 anorectal congenital malformation and anorectal neurological disorders can lead to anal incontinence.
Examine
an examination
Related inspection
Anal finger examination anal inspection
(1) medical history
Need to ask the cause of anal incontinence, the symptoms at the beginning, the severity of the current incontinence, the history of anal rectum, history of radiology, history of injury. Fecal bowel habits, number of bowel movements and fecal texture, with or without history of the nervous system, metabolic diseases and diseases of the urinary system.
(2) Visual inspection
Complete incontinence, common anus opening is round, or deformed, defect, scar, excretion of feces, intestinal fluid, anal skin may have eczema-like changes. Retracting the buttocks by hand, the anal canal is completely relaxed and round, and sometimes the anal canal is partially deficient. Scar formation is often seen from the round hole.
Incomplete incontinence does not close the anus, and there is fecal contamination in the anus when diarrhea occurs.
(three) digital rectal examination
Anal relaxation, contraction of the anal canal sphincter and anorectal ring contraction is not obvious and completely disappeared, if caused by injury, the anus can be scarred and scar tissue, incomplete incontinence can be diagnosed and the sphincter contractility is weakened.
(4) Endoscopy
Proctoscopy can observe the presence or absence of deformity in the anal canal, the mucosal state of the anal canal, and the closure of the anus. Fibrous colonoscopy can be used to observe the presence or absence of colitis, Crohn's disease, polyps, cancer and other diseases. The presence of complete rectal prolapse can be observed with a hard tube colonoscopy.
(5) Defecation contrast examination
The anatomical structure of the anal canal sphincter, anal canal and rectum can be measured. The X-ray barium examination of the dynamic functional state can observe the incontinence and its severity. Inadvertent leakage of a large amount of expectorant is a sign of incontinence.
(6) Anal tube pressure measurement
The internal and external sphincters and the puborectal muscles can be measured for abnormalities. Anorectal inhibition of reflexes, to understand its basic pressure, systolic blood pressure and rectal expansion tolerance capacity. Incontinence patients with anal canal basis, reduced systolic blood pressure, internal sphincter reflex relaxation disappeared, and rectal sensation expansion tolerance capacity decreased.
(7) Electromyography measurement
The range of sphincter function can be determined to determine the degree of voluntary muscle involuntary muscle and its nerve damage and recovery.
(8) Anal ultrasound (AUS) examination
In recent years, the application of anal canal ultrasonography can clearly show the structure of the anorectal submucosa, internal and external sphincter and its surrounding tissue, which can help diagnose anal incontinence and observe the presence or absence of sphincter damage.
Diagnosis
Differential diagnosis
Differential diagnosis of anal relaxation:
1. Anal canal reflex disappears: The anal canal reflex disappears into a kind of shallow reflection in the human nerve reflex. The person lies flat, and the lower extremity is lifted and straightened. The small needle is crossed in the perineal area, and the external anal sphincter will contract. The afferent nerve is the pudendal nerve, the central nucleus of the posterior horn of the medullary 4 to 5 and the anterior horn of the same segment, and the efferent nerve is the pudendal nerve. The external anal sphincter undergoes bilateral perineal innervation. When one side of the pyramidal tract is damaged or the peripheral nerve is damaged, the anal reflex still exists. When the bilateral pyramidal tract is damaged or the cauda equina is damaged, the anal reflex disappears. Incontinence in the elderly can show that the anal canal reflex disappears.
2, fecal incontinence: due to anal or nerve damage, can not control the phenomenon of feces and gas discharge. Also known as defecation incontinence or anal incontinence. Those who can't control dry stools and loose stools, say complete incontinence; those who can control dry stools, can't control loose stools and gas, say incomplete incontinence. Defecation is a complex and coordinated reflex action that is performed under the dual control of the visceral autonomic and cerebral central nervous system. Fecal incontinence can occur with resection of the lower rectum, obstruction of nerve reflexes, and loss of anal sphincter tension. The elderly can cause anal incontinence due to atrophy of the anal sphincter. Temporary fecal incontinence can also occur when you are suddenly shocked.
3, anal sphincter rupture: anal external sphincter rupture caused by a variety of factors, strong mechanical impact of the anus trauma, can lead to the rupture of the external anal sphincter, in addition, accidental surgery can also lead to the fracture of the external anal sphincter, making Fecal incontinence.
