Bowel Dysfunciton

Question 1

Hemorrhoids

Answer 1

varicosities in the superficial rectal vv–internal

inferior rectal vv– external

Question 2

Innervation to rectum & anal canal

Answer 2

Superior to the pectinate line: symp by hypgastric nerves, para by S2-4 pelvic splanchnics

Sup to pectinate line: sensitive to stretching; inference to the pectinate line innervation by inf rectal branch of pudendal nn–sensitivity to pain, temp, touch

Question 3

Anococcygeal Ligament

Answer 3

attaches to EAS (also EAS to perineal body); can be damaged with coccydynia

Question 4

Anorectal angle

Answer 4

formed between axis of rectum and anal canal; normally 80-100 deg;

Varies based on strength of PR, relaxation and position; squatting makes angle bigger, hip flexion>90 deg increases, vol mm relaxation and wknss increase angle

Question 5

Flap-valve mecahanism

Answer 5

If angle is normal: Increase in IAP transfers pressure to the ant rectum to close canal; if angle is larger, IAP opens valve and pushes contents into rectum