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Abnormalities of innervation of internal anal sphincter in fecal incontinence

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Abstract

Physiological and histological studies have shown that the internal anal sphincter is abnormal in idiopathic fecal incontinence. We have recently demonstrated that the invitro contractile response of the internal anal sphincter to the sympathetic neurotransmitter noradrenaline is decreased in incontinence. In this study we have further defined this reduced sensitivity and provided more information about the intrinsic innervation in both the normal and the incontinent sphincter muscle. Muscle strips from 12 incontinent patients undergoing post anal repair and from 11 controls undergoing rectal excision for low rectal carcinoma were studied. Responses to noradrenaline were recorded initially alone and then in the presence of phentolamine, an α-adrenoceptor blocker. In the presence of phentolamine, noradrenaline caused relaxation: there was no significant difference in the relaxation-response curves and the EC50 was the same in the two groups. These results demonstrate that the previously documented reduced sensitivity to noradrenaline is due to an altered sensitivity of the α-adrenoceptors. Electrical field stimulation produced relaxations in all muscle strips, but only in the controls was the magnitude of the relaxation significantly increased in the presence of phentolamine. This indicates that there is an α-adrenergic excitatory component of the response to electrical field stimulation of the intramural nerves, which was present in tissues from control patients but which was absent in tissues from patients with idiopathic fecal incontinence.

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References

  1. Duthie HL, Watts JM: Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 6:64–68, 1965

    Google Scholar 

  2. Frenckner B, von Euler C: Influence of pudendal block on the function of the anal sphincters. Gut 16:482–489, 1975

    Google Scholar 

  3. Lestar B, Penninckx F, Kerremans R: The composition of anal basal pressure. Int J Colorect Dis 4:118–122, 1989

    Google Scholar 

  4. Neill ME, Parks AG, Swash M: Physiological studies of the pelvic floor in idiopathic faecal incontinence and rectal prolapse. Br J Surg 68:531–536, 1981

    Google Scholar 

  5. Sun WM, Read NW, Donnelly TC: Impaired internal anal sphincter in a subgroup of patients with idiopathic fecal incontinence. Gastroenterology 97:130–135, 1989

    Google Scholar 

  6. Lubowski DZ, Nicholls RJ, Burleigh DE, Swash M: Internal anal sphincter in neurogenic fecal incontinence. Gastroenterology 95:997–1002, 1988

    Google Scholar 

  7. Sun WM, Read NW, Miner PB, Kerrigan DD, Donnelly TC: The role of transient internal sphincter relaxation in faecal incontinence? Int J Colorectal Dis 5:31–36, 1990

    Google Scholar 

  8. Kumar D, Waldron DL, Williams NS: Home assessment of anorectal motility and external sphincter EMG in idiopathic faecal incontinence. Br J Surg 76:Abs48, 1989

    Google Scholar 

  9. Duthie GS, Miler R, Bartolo DCC: Internal anal sphincter electromyographic frequency is related to anal canal resting pressure. Both are reduced in idiopathic faecal incontinence. Gut 31:A619, 1990

    Google Scholar 

  10. Speakman CTM, Hoyle CHV, Kamm MM, Henry MM, Nicholls RJ, Burnstock G: Adrenergic control of the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence. Br J Surg 77:1342–1344, 1990

    Google Scholar 

  11. Burleigh DE, D'Mello A, Parks AG: Responses of isolated human internal anal sphincter to drugs and electrical field stimulation. Gastroenterology 77:484–490, 1979

    Google Scholar 

  12. Neill ME, Swash M: Increased motor unit fibre density in the external anal sphincter muscle in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 43:343–347, 1980

    Google Scholar 

  13. Kiff ES, Swash M: Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71:614–616, 1984

    Google Scholar 

  14. Bliss CI: The calculation of the dosage-mortality curve. Ann Appl Biol 22:134–167, 1935

    Google Scholar 

  15. Finney DJ: Probit Analysis, 3rd ed.. Cambridge, Cmbridge University Press, 1971

    Google Scholar 

  16. Waud DR: Analysis of dose-response curves.In Methods of Pharmacology, Vol 3, Smooth Muscle. EE Daniel, DM Paton, (eds). New York, Raven Press, 1975, pp 471–506

    Google Scholar 

  17. Parks AG, Fishlock DJ, Cameron JDH, May H: Preliminary investigation of the pharmacology of the human internal anal sphincter. Gut 10:674–677, 1969

    Google Scholar 

  18. Goyal RK, Rattan S, Said SI: VIP as a possible neurotransmitter of non-cholinergic non-adrenergic inhibitory neurones. Nature 288:378–380, 1969

    Google Scholar 

  19. Rattan S, Chakder S: Role of nitric oxide as a mediator of internal anal sphincter relaxation. Am J Physiol 262:G107-G112, 1992

    Google Scholar 

  20. Reilly WM, Hoyle CHV, Burnstock G: Pre- and postjunctional adrenoceptor types in the circular muscle of the guinea-pig caecum. Naunyn-Schmiedeberg's Arch Pharmacol 336:37–47, 1987

    Google Scholar 

  21. Nurko S, Rattan S: Role of neuropeptide Y in opossum internal anal sphincter. Am J Physiol 258:G59-G64, 1990

    Google Scholar 

  22. Yamato S, Rattan S. Role of alpha adrenoceptors in opossum internal anal sphincter. J Clin Invest 86:424–429, 1990

    Google Scholar 

  23. Gutierrez JG, Shah AN: Autonomic control of the internal anal sphincter in man.In G Van Trappen (ed). Fifth International Symposium of Gastrointestinal Motility. Typoff Press, 1975, pp 363–373

  24. Baumgarten HC, Holstein AF, Stelzner F: Differences in the innervation of the large intestine and internal anal sphincter in mammals and humans. Verh Anat Ges 66:43–47, 1971

    Google Scholar 

  25. Rankin FW, Learnmouth JR: Section of the sympathetic nerves of the distal part of the colon and rectum in the treatment of Hirschsprung's disease and certain types of constipation. Ann Surg 92:710–720, 1930

    Google Scholar 

  26. Carlstedt A, Nordgren S, Fasth S, Appelgren L, Hulten L: Sympathetic nervous influence on the internal anal sphincter and rectum in man. Int J Colorect Dis 3:90–95, 1988

    Google Scholar 

  27. Frencker B, Ihre T: Influence of autonomic nerves on the internal anal sphincter in man. Gut 17:306–312, 1976

    Google Scholar 

  28. Shepherd JJ, Wright PG: The response of the internal anal sphincter in man to stimulation of the pre-sacral nerve. Am J Dig Dis 13:421–427, 1968

    Google Scholar 

  29. Lubowski DZ, Nicholls RJ, Swash M, Jordan MJ: Neural control of internal anal sphincter function. Br J Surg 74:668–670, 1987

    Google Scholar 

  30. Lubowski DZ, Swash M: Effect of sympathetic innervation on human internal anal sphincter. Int J Colorect Dis 6:175–176, 1991

    Google Scholar 

  31. McKirdy HC: Innervation of internal anal sphincter—in vitro studies. Int J Colorect Dis 7:43–44, 1992

    Google Scholar 

  32. Rayner V: Characteristics of the internal anal sphincter and the rectum of the vervet monkey. J Physiol London 286:383–399, 1979

    Google Scholar 

  33. Garrett JR, Howard ER, Jones W: The internal anal sphincter in the cat: A study of nervous mechanisms affecting tone and reflex activity. J Physiol London 243:153–166, 1974

    Google Scholar 

  34. Costa M, Furness JB: The innervation of the internal anal sphincter of the guinea-pig.In Proceedings of the International Symposium on Gastrointestinal Motility, 4th, Vancouver Vancouver, Canada: Mitchell, 1973, pp 681–690

    Google Scholar 

  35. Geffen LB, Hughes CC: Degeneration of sympathetic nervesin vitro and development of smooth muscle super-sensitivity to noradrenaline. J Physiol 221:71–84, 1972

    Google Scholar 

  36. Fleming WW, McPhillips JJ, Westfall DP: Postjunctional supersensitivity and subsensitivity of excitable tissues to drugs. Ergeb Physiol 68:55–119, 1973

    Google Scholar 

  37. Ek B, Bjellin LAC, Lundgren BT: Beta1-adrenergic control of motility in the rat colon. I. Evidence for functional separation of the beta1- and beta2-adrenoceptor mediated inhibition of colon activity. Gastroenterology 90:400–407, 1986

    Google Scholar 

  38. Ek B, Lundgren B: Increased β1 density after 6-hydroxydopamine pretreatment in rat colon and lung. Acta Physiol Scand 127:455–460, 1986

    Google Scholar 

  39. Watanabe Y, Rong-Tsan L, Maeda H, Yoshida H: Reserpine and sympathetic denervation cause an increase of postsynaptic alpha2-adrenoceptors. Eur J Pharmacol 80:105–108, 1982

    Google Scholar 

  40. Reas HW, Trendelenburg U: Changes in the sensitivity of the sweat glands of the cat after denervation. J Pharmacol Exp Ther 156:126–136, 1967

    Google Scholar 

  41. Frigo GM, Lecchini S, Marcoli M, Tonini M, D'Angelo L, Crema A: Changes in sensitivity to inhibitory effects of adrenergic agonists on intestinal motor activity after chronic sympathetic denervation. Naunyn-Schmiedeberg's Arch Pharmacol 325:145–152, 1984

    Google Scholar 

  42. Speakman CTM, Hoyle CHV, Kamm MA, Henry MM, Nicholls RJ, Burnstock G: Decreased sensitivity of muscarinic but not 5-HT receptors in the internal anal sphincter in neurogenic incontinence. Br J Surg 79:829–832, 1992

    Google Scholar 

  43. Hulsebosch CE, Coggleshall RE: An analysis of the axon population in the nerves to the pelvic viscera in the rat. J Comp Neurol 211:1–10, 1982

    Google Scholar 

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Authors and Affiliations

  1. Sir Alan Parks Physiology Unit, St. Mark's Hospital, City Road, EC1V 2PS, London, UK

    Christopher T. M. Speakman MB, BS, FRCS Ed, Charles H. V. Hoyle PhD, Michael M. Kamm MD, MRCP, FRACP, Michael M. Henry MB, FRCS, R. John Nicholls MChir, FRCS & Geoffrey Burnstock PhD, FRS

  2. Department of Anatomy and Developmental Biology and Centre for Neuroscience, University College London, Gower Street, WC1E 6BT, London, UK

    Christopher T. M. Speakman MB, BS, FRCS Ed, Charles H. V. Hoyle PhD, Michael M. Kamm MD, MRCP, FRACP, Michael M. Henry MB, FRCS, R. John Nicholls MChir, FRCS & Geoffrey Burnstock PhD, FRS

Authors
  1. Christopher T. M. Speakman MB, BS, FRCS Ed
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  2. Charles H. V. Hoyle PhD
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  3. Michael M. Kamm MD, MRCP, FRACP
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  4. Michael M. Henry MB, FRCS
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  5. R. John Nicholls MChir, FRCS
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  6. Geoffrey Burnstock PhD, FRS
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Additional information

C.T.M Speakman is supported by the Sir Alan Parks Research Foundation, The Royal College of Surgeons of England. M.A. Kamm by the St. Mark's Research Foundation.

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Speakman, C.T.M., Hoyle, C.H.V., Kamm, M.M. et al. Abnormalities of innervation of internal anal sphincter in fecal incontinence. Digest Dis Sci 38, 1961–1969 (1993). https://doi.org/10.1007/BF01297070

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  • DOI: https://doi.org/10.1007/BF01297070

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