Influence of pudendal block on the function of the anal sphincters

SUMMARY The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block, making it possible to record the activity from the internal sphincter alone. The results show that the internal sphincter contributes about 85 % of the pressure in the anal canal at rest but only about 40 % after a sudden substantial distension of the rectum. During con-stant substantial rectal distension, the internal sphincter accounts for about 65 % of the anal pressure. It is concluded that the internal sphincter in the adult is chiefly responsible for anal continence at rest. In the event of sudden substantial distension of the rectum, continence is maintained by the striated sphincter muscles, whereas both sphincter systems probably have an important function during constant distension of the rectum. The anal canal is kept closed by a ring of muscle and the pressure in this zone is higher as a rule than in the rectum and the sigmoid colon (Hill, Kelley, Schlegel