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Biomedical subjects

M M Henry

Publications and source records attributed to M M Henry.

At least 91 records · Page 5Linked to original sources
PubMed1987

Is paradoxical contraction of puborectalis muscle of functional importance?

Paradoxical contraction of the puborectalis muscle during simulated defecation straining (anismus) has been cited as a cause of constipation. The functional specificity of this phenomenon was evaluated in 79 patients, 50 with constipation, 21 with idiopathic perineal pain, and eight with solitary rectal ulcer syndrome. Electromyogram evidence of paradoxical puborectalis contraction was observed in 38 (76 percent), ten (48 percent), and four (50 percent) of these patients, respectively. All patients with solitary rectal ulcer syndrome had difficulty defecating; defecation was normal in all patients with perineal pain. These observations suggest that paradoxical contraction of the puborectalis muscle is not a specific finding, and that it is not the sole cause of constipation in patients with anismus.

Adolescent↗
PubMed1987

Pathogenesis and management of fecal incontinence in the adult.

In the author's opinion, post-anal repair remains the procedure of choice for patients with levator neuropathy and loss of anorectal angle. The operation is minimally invasive and relatively free of major complications. A knowledge of the anatomy of the perineum and in particular of the intersphincteric space is mandatory before undertaking such surgery. Any surgeon who is accustomed to performing internal anal sphincterotomy will already be accustomed to identifying the plane and the internal sphincter. Progression to performing post-anal repair is only a small step. On the other hand, gracilis transposition seems to be a procedure of considerable technical complexity. Also it must be difficult to gauge the tension of the repair correctly. Presumably it can be all too easy to make the repair too tight and cause a stricture or create a lax repair by leaving too long a length of tendon. However, in patients whose pelvic floor has failed to develop (e.g., in patients with rectal atresia) it is hard to imagine any procedure other than gracilis transposition which can possibly be considered. Clearly, post-anal repair in this case would be contra-indicated. Finally, it is always relevant to remember that colostomy has a creative role to play in the management of anorectal incontinence. In the elderly patient who has a severe atrophy of the pelvic floor the incontinent abdominal wall stoma may be considerably easier to manage than a perineal "stoma." Patients with fecal incontinence are depressed and embarrassed. They have often been told by friends, relatives, and their family doctor that there is little that can be done and not to complain. It is essential in the initial consultation with the patient that this defeatist attitude be countered. Much can be done to restore full function by relatively simple measures which may include surgery. For the surgeon they represent a very gratifying group of patients to treat.

Adult↗
PubMed1986

Risk factors in childbirth causing damage to the pelvic floor innervation.

The innervation of the pelvic floor musculature is damaged in both stress urinary incontinence and idiopathic (neurogenic) anorectal incontinence. Because childbirth has been considered to be a causative factor in stress incontinence we have assessed the effect of childbirth on the innervation of the pelvic floor musculature in 122 consecutively referred women. They were investigated 48-72 h and 2 months after delivery; 51 were also studied 6 months prior to delivery. In 45 of these 51 women delivered vaginally, EMG studies of the external anal sphincter muscle showed that the fibre density (FD) increased from 1.38 +/- 0.14 before delivery to 1.57 +/- 0.19 2 months after delivery (p less than 0.01). There was no change in the FD in the external anal sphincter muscle after delivery in 20 women delivered by Caesarean section. The pudendal nerve terminal motor latency (PNTML) measured 48-72 h after delivery was increased in the 102 women delivered vaginally compared to 34 nulliparous control subjects. Analysis of the whole group of 122 women showed that multiparity, forceps delivery, increased duration of the second stage of labour, third degree perineal tear and high birth weight were important factors leading to pudendal nerve damage. Epidural anaesthesia had no effect on pudendal nerve function. Modification of these obstetric risk factors may ultimately reduce the frequency of stress urinary and faecal incontinence in women.

Adolescent↗
PubMed1986

Current concepts in anorectal physiology.

Anorectal physiology is primarily the study of anal sphincter and pelvic floor muscle function. Coincident with a developing interest in pelvic floor disorders has evolved a need for greater understanding of the normal physiological mechanisms, particularly in regard to faecal incontinence, and for increasingly sophisticated techniques whereby such function may be studied.

Anal Canal↗
PubMed1985

Electrophysiological and manometric assessment of the pelvic floor in the solitary rectal ulcer syndrome.

Fifteen of twenty patients with the solitary rectal ulcer syndrome, eighteen of whom were women, had evidence of reinnervation in the external anal sphincter muscle as demonstrated by single fibre EMG and nine of these patients had an increased pudendal nerve terminal motor latency. In ten patients there was paradoxical puborectalis muscle activity on straining, but damage to the innervation of the external anal sphincter muscle was correlated with a history of straining, and with excessive perineal descent, rather than with paradoxical puborectalis activity. We suggest that this syndrome does not have a single cause.

Adult↗
PubMed1985

Damage to the innervation of the pelvic floor musculature in chronic constipation.

Constipation and defecation straining have been implicated in the pathogenesis of anorectal incontinence. We have studied 24 women with chronic constipation and 20 age- and parity-matched control subjects. Electrophysiologic techniques were used to study the innervations of the puborectalis and external anal sphincter muscles. The results show that damage can occur to the nerve supply of both these muscles in chronic constipation, and that this probably is due to perineal descent during defecation straining.

Adult↗
PubMed1985

Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology.

The commonest cause of external anal sphincter division is injury during childbirth. We have studied 20 patients with anterior external anal sphincter division using physical and electrophysiological techniques. There was evidence of pudendal nerve damage in 60% of these patients. This finding suggests that damage to the innervation of the external anal sphincter often co-exists with direct injury to the muscle; in these patients pelvic floor surgery may be required, in addition to sphincter repair itself.

Adult↗
PubMed1985

Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles.

The innervation of the puborectalis and external anal sphincter muscles was studied in 32 patients with idiopathic (neurogenic) faecal incontinence, 12 of whom also had complete rectal prolapse, using transcutaneous spinal stimulation, transrectal pudendal nerve stimulation, single fibre EMG, anorectal manometry, and measurement of perineal descent. Fourteen normal subjects served as controls. Significant increases in the spinal motor latencies from L1 to the puborectalis and external anal sphincter muscles were shown in all 32 incontinent patients (p less than 0.01). The single fibre (EMG) fibre density was increased in the puborectalis muscle in 60% and in the external anal sphincter in 75% of patients. An increased pudendal nerve terminal motor latency was found in 68% of patients; 69% had an abnormal degree of perineal descent and all had reduced anal canal contraction pressures. These data show that the different innervations of the puborectalis and external anal sphincter muscles are both damaged in patients with anorectal incontinence.

Adult↗
PubMed1985

Unifying concept of pelvic floor disorders and incontinence.

Denervation of pelvic floor sphincter muscles is a feature of pelvic floor disorders. When severe, it may be accompanied by stress incontinence of faeces, or of urine. The extent of chronic partial denervation of these pelvic floor muscles can be quantified by electromyography (EMG), and its cause identified by electrophysiological studies of the motor innervation of these striated muscles. Damage to this innervation is often initiated by childbirth, but appears to progress during a period of many years so that the functional disorder usually presents in middle life. Incontinence develops in some patients, but not in others. This can be predicted by the severity of the abnormalities found in EMG studies of the pelvic sphincter musculature and motor latency studies of its innervation. The results of such investigations in the six common types of pelvic floor disorder are presented. Recognition of the causative factors leading to damage to the innervation of the pelvic sphincter muscles implies new approaches to treatment and to prevention of pelvic floor disorders and incontinence.

Adult↗
PubMed1985

A quantitative study of the development of interalveolar pores in the postnatal mouse.

Quantitative analysis of regional interalveolar pore development in the lungs of C3Hf/He mice was performed using scanning electron microscopy. Lungs of male mice ages 7, 10, 14, 21, 28, and 56 days were studied following intratracheal fixation. Interalveolar pores were counted in subpleural, midzonal, and peribronchiolar regions. Interalveolar pores were rarely observed in mice ages 7, 10, and 14 days but appeared abruptly at age 21 days throughout the lung. The number of interalveolar pores increased 2-3 fold from ages 21 to 56 days. By age 28 days and thereafter interalveolar pores were more numerous in subpleural alveoli than in midzonal or peribronchiolar alveoli. We conclude that interalveolar pores appear diffusely in the lungs of mice during the third postnatal week and that regional differences in the number of interalveolar pores are established by age 28 days.

Aging↗
PubMed1985

Investigation of disorders of the anorectum and colon.

Previously, investigation of disorders of the anorectum and colon have been limited to manometric, external anal sphincter muscle electromyographic and contrast radiological techniques. In this paper we describe other investigative techniques recently developed at St. Mark's Hospital, London and their application in the investigation of certain disorders of the anorectum and colon.

Anal Canal↗
PubMed1984

Injury to innervation of pelvic floor sphincter musculature in childbirth.

71 women delivered at St Bartholomew's Hospital, London, were studied by electrophysiological tests of the innervation of the external anal sphincter muscle and by manometry. The investigations were done 2-3 days after delivery and again, in 70% of these women, 2 months later. Faecal and urinary incontinence developing after vaginal delivery has been thought to be due to direct sphincter division, or muscle stretching, but the results of the study suggest that in most cases this incontinence results from damage to the innervation of the pelvic floor muscles.

Adolescent↗
PubMed1984

Faecal incontinence after anal dilatation.

We have studied 10 patients with faecal incontinence occurring after anal dilatation. Abnormalities were found in the external and sphincter in clinical and manometric tests in five patients and in single fibre EMG tests in four patients. Internal anal sphincter function was impaired in eight patients. These findings have implications for prevention of faecal incontinence after this procedure.

Adult↗
PubMed1984

The anal sphincter.

The anal sphincter has not generally stimulated great scientific interest although anatomical and physiological disorders of this region are common and may be the cause of considerable suffering to the individual affected. Over the last decade there has, however, been an accelerating interest in the function of this important sphincter.

Anal Canal↗