Insufficiency of an anal sphincter – a state at which the patient in whole or in part cannot hold rectum contents. Manifestations depend on degree and a cause of illness. At sfinkterny insufficiency the incontience of gases, liquid or firm a calla is possible; symptoms can disturb for day or at night, during rest, physical or nervous tension. Pathology is diagnosed by means of a sfinkterometriya, a profilometriya; as auxiliary methods use an anoskopiya, a rektoromanoskopiya, a radiological research of a rectum, an irrigoskopiya, an electromyography. Tactics conservative or quick.
Insufficiency of an anal sphincter
Insufficiency of an anal sphincter is the pathology which is followed by full or partial inability of the person to control defecation process, uncontrolled release of gases, liquid or firm kalovy masses. There are no reliable statistical data about prevalence of pathology in population as at early stages patients can not ask for medical care. It is considered that insufficiency of an anal sphincter comes to light approximately at 1-2% of people, often arises as a complication of other diseases of a rectum (for example, hemorrhoids, loss of a rectum etc.). In most cases patients suffer 40 years are more senior. At congenital insufficiency of an anal sphincter or in case of neurologic violations the age barrier can decrease. Pathology meets approximately identical frequency at men and at women. Specialists of offices of a proktologiya are engaged in diagnostics and therapy of insufficiency of an anal sphincter.
Reasons of insufficiency of an anal sphincter
Deduction a calla an anus happens due to difficult interaction between the receptor device of a rectum, different parts of the nervous system and smooth muscles of the locking device and walls of a rectum. These mechanisms regulate tonic conscious strong-willed deduction of kalovy masses in intestines. At organic defeats of rectal department an incontience the calla occurs owing to hems and in disteel sites of a rectum, pathological changes of muscles which violations of a vermicular movement of intestines join.
Failure of nervous regulation of an external sphincter leads to involuntary defecation at the time of overflow of intestines or at a considerable physical tension. If structures of a wall of a gut are surprised, the incontience is noted in a dream or at an emotional stress when conscious mechanisms are switched-off. Changes in receptors of disteel departments lead to lack of feeling of overflow of a rectum and desires to defecation at the patient. Diseases of the central nervous system provoke a diskoordination of work of sphincters.
Most often insufficiency of an anal sphincter arises because of injuries, functional frustration, congenital defects. The main reason for injuries – operations and childbirth, is more rare household damages. Functional insufficiency of an anal sphincter develops as a result of chronic diseases of a large intestine (proktit, hemorrhoids, etc.) which conduct to an atrophy of smooth muscles, receptors, motility violation. At loss of gemorroidalny knots, a mucous membrane of a rectum the sphincter excessively stretches that too breaks its function. Insufficiency of an anal sphincter provoke diseases of a head or spinal cord, and also peripheral nerves (ChMT, intracerebral tumors, strokes, intervertebral hernias).
Congenital weakness of a sphincter can be connected with anomalies of development of nervous system (bifurcation of a spinal cord, an incomplete zarashcheniye of arches of sacral vertebras), changes of this kind have functional character. Organic insufficiency of an anal sphincter at newborns arises because of absence (full or partial) the device performing switching function.
Classification of insufficiency of an anal sphincter
In a form allocate the following types of insufficiency of an anal sphincter:
Taking into account etiologichesky factors pathology is divided on congenital and developing after injuries (including postnatal and postoperative). In the clinical course of a disease differentiate three severity taking into account that how the patient can keep the kalovy masses and gases.
Weakness of the sfinkterny device can be caused by involvement in pathological process of an internal or external sphincter, muscles of a pelvic bottom. The defeats connected with an innervation can be formed at the central level or at the level of the carrying-out nervous ways, nervous receptors.
Organic pathology with changes in muscular structure of a sphincter can concern its lobby, back or a sidewall, to be combined or to mention a locking ring on all its circle. Process can affect less than a quarter of a circle, 1/4, less than a half, 1/2 part, 3/4 or all circle of a sphincter.
Symptoms of insufficiency of an anal sphincter
Insufficiency of an anal sphincter is shown by involuntary release of gases, liquid or firm kalovy masses from a rectum. Intensity of symptoms depends on disease degree. At the first degree the incontience only of gases is observed. At the second degree uncontrolledly there are gases and liquid kcal. Diagnose a so-called "wet anus" for the patient. The third degree of insufficiency of an anal sphincter is characterized by impossibility to keep the created kalovy masses. Often these symptoms are accompanied by complaints to a meteorizm, ponosa, an itch in a crotch and near an anus.
Problems with an external sphincter are most often shown by involuntary defecation at the crowded intestines. Pathology of an internal sphincter can be followed by allocation of kalovy masses during sleep. If the patient does not feel desires to defecation, then insufficiency of an anal sphincter, most likely, is connected with serious problems in the central nervous system, different damages of receptors in the lower departments of a rektum.
Diagnostics of insufficiency of an anal sphincter
At survey of the patient the proctologist reveals a sphincter gaping symptom, maceration around an anus because of constant irritation of skin liquid kalovy masses. The manual rectal research helps to reveal cicatricial changes in a rectal ampoule, and also to approximately define switching function of a sphincter.
At insufficiency of an anal sphincter first of all conduct functional researches. By means of a sfinkterometriya study sokratitelny function and tonic tension of sphincters, muscles of the lower sites of a rectum. This method helps to define in what place there was a problem of insufficiency of an anal sphincter: in its internal department, external or in rectum muscles, and at the combined pathology – what functional changes are more essential. Besides, for studying of a muscular tone use an electromyography method.
Diagnostics of reflex function of the sfinkterny device is of great importance. Carry out it by irritation by the special probe of skin near an anus. Profilometriya gives the chance to determine pressure in a rectum, to reveal, cicatricial defeats are how widespread and to estimate extent of change of functionality of the locking device.
For clarification of the reasons of insufficiency of an anal sphincter and search of the accompanying pathologies carry out an anoskopiya and a rektoromanoskopiya. These techniques allow to find cicatricial changes, striktura. The X-ray analysis with contrast gives the chance to measure an anorektalny corner, to study a relief and structure of a rectum. If necessary the research is supplemented with an irrigoskopiya. For detection of diseases which can accompany insufficiency of an anal sphincter carry out a kolonoskopiya.
Treatment of insufficiency of an anal sphincter
At a functional etiology of insufficiency of an anal sphincter conservative therapy remains the only way of treatment so far. Also therapeutic tactics is used at patients with the first and second extent of violations, at organic defeats to one quarter of the sfinkterny device, with involvement only of the top layers of a mucous rectum and lack of its defects. Appoint electrostimulation sessions, physiotherapy exercises, medicines which increase excitability of the nervous terminations. Recently in a proktologiya the method of the return biological communication gains ground (). Its essence consists in trainings of muscles of a bottom of a basin and an anus with active participation of the patient.
Expeditious treatment carry out more than a quarter of extent of the locking device at organic insufficiency of an anal sphincter of the second or third degree, defeat. Operations at changes in system of an innervation are contraindicated. Make a sfinkteroplastika, a sfinkterolevatoroplastika for renewal of activity of sphincters, at considerable violations form the new sfinkterny device. For treatment of congenital defects use Stone's operation.
Forecast and prevention of insufficiency of an anal sphincter
The forecast at insufficiency of an anal sphincter depends on a look and extent of defeat. Serious diseases of the central nervous system, nervous conductors, massive cicatricial changes in a rectum complicate treatment. However adequate conservative therapy and the correct surgical tactics at moderate degree of pathology allow to reduce symptoms or completely will get rid of them. Complications at this state arise seldom, but quality of life therefore patients need to address the proctologist in due time considerably decreases.
Prevention of insufficiency of a rectal sphincter consists in adequate therapy of diseases of a large intestine, improvement of operational techniques of treatment of diseases of a rectum and their correct carrying out. Adequate tactics of conducting childbirth which allows to avoid considerable injuries is also important.