Using EMG-biofeedback, the patients learned to relax
external anal sphincter to permit defecation, decreasing significantly the anismus index.
In normal patients, any action that increases intra-abdominal pressure -- such as sneezing, coughing, rising from a chair, walking and even talking -- is always accompanied by compensatory increases in the activity of the
external anal sphincter and puborectalis muscles.
Often, obstetricians try to ensure that the knots are buried within the body of the
external anal sphincter muscle, rather than on the surface of the fascial sheath of the sphincter.
Table 1 : MRI scoring of
External Anal Sphincter and Puborectalis Muscle Good SMC Age Group EAS (mm) PR (mm) 6m-3yrs 3 [+ or -] 0.2 3.1 [+ or -] 0.3 Upto 7 yrs 3.4 [+ or -] 0.3 3.8 [+ or -] 0.2 Upto 14 yrs 4.0 [+ or -] 0.4 4.7 [+ or -] 0.4 Fai/Moderate Poor/Severe Hypoplasia Hypoplasia Age Group EAS (mm) PR (mm) EAS (mm) PR (mm) 6m-3yrs 2-2.9 2.1-3.1 <2 <2.1 Upto 7 yrs 2.4-3.3 2.8-3.7 <2.4 <2.8 Upto 14 yrs 3-3.9 3.7-4.6 < 3 < 3.7 (EAS-external anal sphincter, PR-puborectalis) (Values mentioned under Good SMC are mean with standard deviation).
External anal sphincters (EAS), is 5mm thick and has of mixed echogenicity, with a white layer deficient anteriorly & superiorly.
The internal anal sphincter should be closed with the same fine interrupted or running sutures, and the
external anal sphincter should be closed using 2-0 prolonged delayed absorbable (PDS/Maxon) sutures with either an overlapping or end-to-end technique.
Ultrasound identified anal sphincter defects in the
external anal sphincter (61% of women), internal anal sphincter (3%), or both (36%).
For the
external anal sphincter, use 2-0 prolonged delayed sutures (such as PDS II or Maxon), she advised, noting that second-degree repair and perineorrhaphy may be necessary to reattach the rectovaginal septum to the perineal body, thus restoring normal anatomy.
The
external anal sphincter and puborectalis muscles reveal their tone as the patient squeezes.
The
external anal sphincter is then mobilized and an overlapping repair is done.
Movement of feces out of the rectum is prevented by the internal and
external anal sphincters and the pelvic floor muscles, particularly the pubo-rectalis muscle.
The lesion appeared to originate from between the internal and
external anal sphincters, with the superior part of the lesion therefore lying in the intersphincteric plane and the lower part bulging out into the perineum.