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Primary sphincter repair is inadequate in most women with obstetric ruptures following vaginal delivery. Residual sphincter defects remain in most and around 50% remain incontinent. If there is a residual sphincter defect following the operation (as demonstrated by endoanal ultrasonography), then the procedure may be repeated. [4] [5]
The muscle helps maintain continence of urine along with the internal urethral sphincter which is under control of the autonomic nervous system.The external sphincter muscle prevents urine leakage as the muscle is tonically contracted via somatic fibers that originate in Onuf's nucleus and pass through sacral spinal nerves S2-S4 then the pudendal nerve to synapse on the muscle.
Between 2004 and 2005 there was a personal experience in the similar technique by group of surgeons. That technique included coring out the intersphinteric fistula tract from the external opening to the external sphincter, excision of the intersphincteric fistula tract and suture of the internal sphincter defect through the intersphincteric plane.
The internal sphincter is a continuation of the detrusor muscle and is made of smooth muscle, therefore it is under involuntary or autonomic control. This is the primary muscle for prohibiting urination. The female or male external sphincter muscle of urethra (sphincter urethrae): located in the deep perineal pouch, at the bladder's distal ...
The sutures are pulled up under tension and tied. The retracted ends of external sphincter muscle are now brought closer to the anterior midline of the anus. The ends of the sphincter are sutured together to perineal body. Two sutures are placed in the rectal fascia to lessen the tension on the sphincter ends.
The sphincter is separated either by simply stretching or cutting. Cutting the muscle prevents spasm and temporarily weakens the muscles. Both methods help the underlying area to heal. Remove the fissure and any underlying scar tissue. Suture back the wound. [4]
[citation needed] During the procedure the external anal sphincter muscle is pulled in when the anal cushion is cut followed tight stapling with 2 rows of 28 staples so if external hemorrhoids are present they also get pulled in and get hidden inside and get tucked inside the anal canal and reappear when the staples fall after a few months when ...
The external anal sphincter (or sphincter ani externus) is an oval tube of skeletal muscle fibers. [1] Distally, it is adherent to the skin surrounding the margin of the anus. [2] It exhibits a resting state of tonical contraction [1] and also contracts during the bulbospongiosus reflex. [3] [4] [5] [6]