Parks A G, Swash M, Urich H
Gut. 1977 Aug;18(8):656-65. doi: 10.1136/gut.18.8.656.
Biopsies of the external anal sphincter, puborectalis, and levator ani muscles have been examined in 24 women and one man with long-standing anorectal incontinence, 18 of whom also had rectal prolapse, and in two men with rectal prolapse alone. In 16 of the women anorectal incontinence was of unknown cause, but in eight there was a history of difficult labour. Similar biopsies were examined in six control subjects. In all the incontinent patients there was histological evidence of denervation, which was most prominent in the external anal sphincter muscle biopsies, and least prominent in the levator ani muscles. Myopathic features, which were thought to be secondary, were present in the more abnormal biopsies. There were severe histological abnormalities in small nerves supplying the external anal sphincter muscle in the three cases in which material was available for study. We suggest that idiopathic anorectal incontinence may be the result of denervation of the muscles of the anorectal sling, and of the anal sphincter mechanism. This could result from entrapment or stretch injury of the pudendal or perineal nerves occurring as a consequence of rectal descent induced during repeated defaecation straining, or from injuries to these nerves associated with childbirth.
对24名患有长期肛门直肠失禁的女性和1名男性以及2名仅患有直肠脱垂的男性的肛门外括约肌、耻骨直肠肌和肛提肌进行了活检。其中18名女性还患有直肠脱垂。在16名女性中，肛门直肠失禁病因不明，但8名有难产史。对6名对照受试者进行了类似的活检。在所有失禁患者中，均有去神经支配的组织学证据，这在肛门外括约肌活检中最为明显，在肛提肌活检中最不明显。在异常程度较高的活检中存在被认为是继发性的肌病特征。在可用于研究的3例病例中，供应肛门外括约肌的小神经存在严重的组织学异常。我们认为，特发性肛门直肠失禁可能是肛门直肠吊带肌和肛门括约肌机制去神经支配的结果。这可能是由于反复排便用力时直肠下降导致阴部神经或会阴神经受压或拉伸损伤，或与分娩相关的这些神经损伤所致。
