Abstract
The effect of sympathetic nerve block and efferent stimulation of the sympathetic nerves on anorectal motility was studied in 21 patients undergoing operation for rectal carcinoma. Anal pressure and rectal volume were simultaneously recorded before and after epidural anaesthesia and during nerve stimulation. Efferent electrical stimulation of the presacral hypogastric nerves (HGN) elicited a contraction of the internal anal sphincter (IAS) in 13 out of 15 patients. The contraction was preceded by a relaxation in seven patients. In the rectum stimulation of the HGN caused variable responses. A weak contraction was the most frequent response. Efferent stimulation of the periarterial lumbar colonic nerves (LCN) elicited a clear-cut contraction of the IAS, while rectal motor responses were only occasionally observed. Epidural anaesthesia encompassing the thoraco-lumbar region (EDA), when used to block the sympathetic discharge to the IAS and the rectum, caused a reduction of anal pressure (28±11%) and an increased rectal tone. The results imply that the human IAS receives a sympathetic excitatory innervation via both the HGN and the LCN. Furthermore, it appears that the HGN convey inhibitory fibres to the IAS. The rectal responses to EDA and sympathetic nerve stimulation also indicate the presence of both excitatory and inhibitory neurones in the sympathetic nerve supply to the rectum in man.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Langley JN, Anderson HK (1895) On the innervation of the pelvic and adjoining viscera. J Physiol 18:67–105
Garrett JR, Howard ER, Jones W (1974) The internal anal sphincter in the cat: a study of nervous mechanisms affecting tone and reflex activity. J Physiol 243:153–166
Bouvier M, Gonella J (1981) Nervous control of the internal anal sphincter of the cat. J Physiol 310:457–469
Carlstedt A, Fasth S, Hultén L, Nordgren S (in press) The sympathetic innervation of the internal anal sphincter and rectum in the cat. Acta Chir Scand
Frenckner B, Ihre T (1976) Influence of autonomic nerves on the internal anal sphincter in man. Gut 17:306–312
Rankin FW, Learmonth JR (1930) Section of the sympathetic nerves of the distal part of the colon and rectum in the treatment of Hirschsprung's disease and certain types of constipation. Ann Surg 92:710–720
Shepard J, Wright PG (1968) The response of the internal anal sphincter in man to stimulation of the presacral nerve. Am J Dig Dis 13:421–427
Lubowski DZ, Nicholls RJ, Swash M, Jordan MJ (1987) Neural control of internal anal sphincter function. Br J Surg 74:668–670
Learmonth JR, Markowitz J (1929) Studies on the function of the lumbar sympathetic outflow. Am J Physiol 89:686–691
Mizutani M, Nakayama S (1986) Role of lumbar colonic nerves on internal anal sphincter motility in dogs. Ital J Gastroenterol 18:134–139
Rayner V (1979) Characteristics of the internal anal sphincter and the rectum of the vervet monkey. J Physiol 286:383–399
Hedlund H, Fasth S, Hultén L (1984) Efferent sympathetic nervous control of rectal motility in the cat. Acta Physiol Scand 121:317–324
Lyrenäs E, Abrahamson H, Dotewall G (1985) Effects of beta-adrenoceptor stimulation on recto-sigmoid motility in man. Dig Dis Sci 6:536–540
Gagnon DJ, Devroede G, Belisle S (1972) Excitatory effects of adrenaline upon isolated preparations of human colon. Gut 13:654–657
Fasth S, Hultén L, Nordgren S, Åkervall S, Öresland T (in press) Manovolumetry — a new method for investigation of anorectal function. Gut
Gutierrez JG, Shah AN (1975) Autonomic control of the internal anal sphincter in man. In: Van Trappen G (ed) Fifth International Symposium of Gastrointestinal Motility. Typoff Press, pp 363–373
Parks AG, Fishlock DJ, Cameron JDH, May H (1969) Preliminary investigation of the pharmacology of the human internal anal sphincter. Gut 10:674–677
Friedmann CA (1968) The action of nicotine and catecholamines on the human internal anal sphincter. Am J Dig Dis 13:428–431
Burleigh DE, D'Mello A, Parks AG (1979) Responses of isolated human internal anal sphincter to drugs and electrical field stimulation. Gastroenterology 77:484–490
Burnstock G (1976) Do some nerve cells release more than one transmitter? Neuroscience 1:239–248
Hultén L (1969) Extrinsic nervous control of colonic motility and blood flow. Acta Physiol Scand [Suppl] 335:1–116
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Carlstedt, A., Nordgren, S., Fasth, S. et al. Sympathetic nervous influence on the internal anal sphincter and rectum in man. Int J Colorect Dis 3, 90–95 (1988). https://doi.org/10.1007/BF01645312
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01645312