Shafik A
Dis Colon Rectum. 1980 Jan-Feb;23(1):37-43. doi: 10.1007/BF02587198.
The role of the external and internal anal sphincters in the mechanism of anal continence is presented. The external sphincter induces continence by 1) preventing internal sphincter relaxation, what I have called the "voluntary inhibition action," and 2) mechanical compression of the rectal neck and anal canal proper. The mechanism of both actions is described. The internal sphincter plays a significant role not only in involuntary, but also in voluntary, continence. The importance of this role in the correction of anal incontinence is clarified. "Stress defecation," a condition which follows internal sphincter damage, is discussed. A "single loop continence" theory is presented, based on the fact that each of the three loops of the external sphincter has its own innervation, attachment, and direction of muscle bundles; each loop thus acts as a separate sphincter. The clinical application of this theory is presented.
本文阐述了肛门外括约肌和内括约肌在肛门节制机制中的作用。外括约肌通过以下方式诱导节制：1）防止内括约肌松弛，我称之为“自主抑制作用”；2）对直肠颈部和肛管本身进行机械性压迫。对这两种作用的机制进行了描述。内括约肌不仅在非自主性节制中，而且在自主性节制中都发挥着重要作用。阐明了这一作用在肛门失禁矫正中的重要性。讨论了内括约肌损伤后出现的“应力性排便”情况。基于外括约肌的三个环各自具有其自身的神经支配、附着点和肌束方向这一事实，提出了“单环节制”理论；因此，每个环都作为一个独立的括约肌起作用。介绍了该理论的临床应用。
