Stelzner F, Beyenburg S, Hahn N
Zentrum für Chirurigie, Chirurgische Universitätsklinik, Bonn-Venusberg.
Langenbecks Arch Chir. 1993;378(1):49-59. doi: 10.1007/BF00207995.
The peritoneal cavity has a fascial skeleton that is kept under tension by permanent variable resting tone maintained by the abdominal muscles. The lateral abdominal muscles, the diaphragm and the pelvic floor are all components of this fasciomuscular support system. Voluntary and reflective changes in muscle tension allow the entry and exit of matter into and out of the spherical abdominal cavity by opening and closing of specialized wall segments called sphincters. We have previously demonstrated the existence of a resting tone in the tail muscles of mammals from which the human pelvic floor muscles are derived. The pelvic floor and its integrated sphincters form the anorectal organ of continence. This organ is much weaker in females than in males. The spinal centers that govern continence, contain in the female significantly fewer ganglion cells than the corresponding centers in the male. Childbirth and a commonly found tendency to develop constipation are additional stressors for the congenitally weaker female organ of continence. We explain in this paper why the abdominal wall and the pelvic floor may suffer stretch-induced denervation injuries during pregnancy and delivery. Such damage may persist in later life and can give rise to incontinence and "flabby abdomen". Based on our work in this field, we found a new differentiation between continent and incontinent constipation. Continent constipation is caused by spasticity of the pelvic floor characterized by abnormally high sphincter activity. This spastic pelvic floor syndrome can be treated successfully by psychotherapeutic techniques. Incontinent constipation, in contrast, is always associated with subnormal activity of the sphincters and may be a cause of rectal prolapse. It can be treated successfully by anterior rectosigmoid resection. Incontinent constipation will also require operative approximation of the levators in many cases. Improvement cannot be expected to result from this procedure, however, unless the pelvic floor shows some residual resting activity.
腹膜腔有一个筋膜骨架，其通过腹肌维持的永久性可变静息张力而保持在张力状态。腹外侧肌、膈肌和盆底都是这个筋膜肌肉支持系统的组成部分。肌肉张力的自主和反射性变化通过称为括约肌的特殊壁段的打开和关闭，允许物质进出球形腹腔。我们之前已经证明了源自人类盆底肌肉的哺乳动物尾部肌肉中存在静息张力。盆底及其整合的括约肌形成了控便的肛肠器官。这个器官在女性中比在男性中要弱得多。控制排尿的脊髓中枢，女性的神经节细胞明显少于男性的相应中枢。分娩和常见的便秘倾向是先天性较弱的女性控便器官的额外压力源。我们在本文中解释了为什么腹壁和盆底在怀孕和分娩期间可能会遭受拉伸引起的去神经损伤。这种损伤可能在以后的生活中持续存在，并可能导致尿失禁和“腹部松弛”。基于我们在该领域的工作，我们发现了便秘型和失禁型便秘之间的新区别。便秘型便秘是由盆底痉挛引起的，其特征是括约肌活动异常高。这种痉挛性盆底综合征可以通过心理治疗技术成功治疗。相比之下，失禁型便秘总是与括约肌活动不足有关，可能是直肠脱垂的一个原因。它可以通过直肠乙状结肠前切除术成功治疗。在许多情况下，失禁型便秘还需要对提肌进行手术复位。然而，除非盆底显示出一些残余的静息活动，否则不能期望通过这个手术得到改善。
