A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. The involuntary action of the external anal sphincter: histologic study.

The histologic changes in the external anal sphincter after internal anal sphincter excision were studied in 20 dogs. An external sphincter biopsy was taken before internal sphincterectomy and 2 weeks and monthly thereafter for 10 months. The excised material was studied microscopically after being stained with hematoxylin and eosin, Verhoeff-van Gieson and succinic dehydrogenase. 70% of external sphincter specimens before internal sphincter excision showed smooth muscle fibers scattered between the striated fibers. These smooth fibers could be responsible for the resting tone of the external sphincter. After internal sphincter excision, characteristic histologic changes could be identified in the external sphincter. From the 2nd week to the 5th month after excision, the external sphincter showed degenerative and hypertrophic changes. From the 6th to the 10th month, there were regeneration of the striated muscle fibers and increase in the number of smooth fibers so that by the 10th month a 'compound' muscle of striated and smooth fibers was identified. Two theories were put forward to explain the smooth fiber preponderance in the external sphincter after internal sphincter excision: mutant and replacement theories. The increased nonstriated element in the external sphincter seems to be a structural-functional adaptation so that the external sphincter takes on the involuntary function of the excised muscle.