Towards safer treatments for benign anorectal disease: the pharmacological manipulation of the internal anal sphincter.

Annals of the Royal College of Surgeons of England
O M Jones

Abstract

The internal anal sphincter (IAS) is an important structure that is responsible for the majority of resting tone of the sphincter complex. It has a central role in continence and damage to the muscle has serious implications. Injury is most frequently from obstetric trauma though iatrogenic injury from proctological surgery is also common. This review expands on how developments in understanding of the pharmacology of IAS might identify drug treatments as alternatives for proctological conditions such as anal fissure, avoiding the risk of sphincter injury. It also examines the role of pharmacology in treatment of those patients with established incontinence. Much of the basic physiology and pharmacology of the IAS has been established through in vitro analysis, particularly in the superfusion organ bath. Further analysis has been undertaken using animal models such the pig. Clinical trials have established the efficacy of a number of agents for reducing IAS tone including glyceryl trinitrate and botulinum toxin. These drugs are probably safer, but less effective, than surgery for sphincter spasm, as is seen in anal fissure, though surgery alone or in combination with drug treatment may be appropriate for some patients. In vitro...Continue Reading

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Apr 7, 2005·Diseases of the Colon and Rectum·Oliver M JonesNeil J McC Mortensen

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Citations

Feb 4, 2010·International Journal of Colorectal Disease·José GilPascual Parrilla
Jan 8, 2011·International Journal of Colorectal Disease·Muhammad Rafay Sameem SiddiquiAl Mutaz Abulafi
Sep 1, 2008·Journal of Ultrasound·L M SconfienzaG Serafini
Sep 30, 2010·Neurourology and Urodynamics·Thanesan RamalingamAlison F Brading
Oct 31, 2017·Techniques in Coloproctology·P RavindranS I White

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