PubMed · 3359160
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A M Roe. 1988. Outlet obstruction.. https://doi.org/10.1002/bjs.1800750434
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PURPOSE: The effects of biofeedback (BF) on pain relief and anorectal physiology in patients with levator ani syndrome (LAS) were prospectively studied. METHOD: Sixteen consecutive patients (9 men, 7 women; mean age, 50.1 (range, 39-66) years) with LAS were treated with BF from July 1993 to October 1995. Mean duration of pain was 32.5 (standard error of the mean, 6.7) months. All underwent a full course of BF using a manometric balloon technique. Mean follow-up was 12.8 (standard error of the mean, 2.6) months. Pain score and anorectal physiology tests were administered prospectively by an independent observer before and after BF. RESULTS: After BF, the pain score was significantly improved (before BF: median, 8 (range, 6-10); after BF: median, 2 (range, 1-4); P < 0.02). Analgesic requirements were also significantly reduced (all 16 patients needed nonsteroidal anti-inflammatory drugs (NSAID) before BF; only two patients needed NSAID after BF; P < 0.03). There were no significant changes to the anorectal physiology parameters after BF. To date, there have been no side effects or regressions. CONCLUSION: Although BF had a negligible effect on anorectal physiologic measurements in LAS, it was effective in pain relief, with no side effects.
The projections of enteric neurons showing immunoreactivity for vasoactive intestinal peptide (VIP), nitric oxide synthase (NOS) and galanin were investigated in the myenteric plexus of the intestine of the Atlantic cod, Gadus morhua. Quantification of immunoreactive material on the proximal and distal side of a myotomy was performed by means of confocal laser scanning microscopy. NOS immunoreactivity was reduced anal to the myotomy, whereas there was an accumulation of immunoreactivity for VIP and for galanin oral to the cut. These results suggest the presence of VIP, NOS and galanin in neurons with oral-to-anal projections along the intestine of the cod. Since descending neurons in the myenteric plexus of many other vertebrates also contain these substances, we conclude that the oral-to-anal projections of neurons containing VIP, NOS and galanin are highly conserved features and important for the descending phase of intestinal peristalsis on an evolutionary basis.
In sacral anoplasty, it is frequently found that an outer layer of the rectal wall, which resembles the structure of the taenia bands of the colon, limits the elasticity of the rectum making it different from the small intestine, hence preventing the rectal stump from being advanced to reach the perineum. Results of autopsy studies on 40 human babies and 40 dogs showed that a special collagenous fibrous layer called adventitia rectalis was found to limit the free expansion of the rectal wall. This was responsible for keeping the rectum a straight tubular shape with a fixed volume. This tissue plays an important role in bowel movement by defining a threshold of intrarectal pressure in the bowel reflex of defecation and by transmitting the expulsive force from the abdomen above down to the anal opening. This discovery may explain why (1) in Hirschsprung's disease, the preservation of the rectal wall in Soave's or Rehbein's procedure or partial preservation in Duhamel's operation will preserve better bowel function; (2) in atresia ani, rectal tapering results in better bowel control than rectal pouch amputation; and (3) in sacral anoplasty, multiple releasing incisions of adventitia rectalis at different levels will lengthen the rectal stump to about double its original length to reach the perineal incision, and the divided fibers will soon regenerate.