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February 5, 1973

Office Treatment of Rectal and Anal Diseases

Author Affiliations

From Harvard Medical School and Massachusetts General Hospital, Boston.

JAMA. 1973;223(6):676-680. doi:10.1001/jama.1973.03220060050012

Considering the role of the rectum and anus as a conduit for excretion of gaseous, liquid, or solid waste with high concentrations of infective bacteria, their functions are remarkably efficient and trouble-free. In fact, discrimination, continence, and defecation are accomplished largely at reflex levels with acute consciousness of anorectal function being reserved for states of deliberate continence of defecation, malfunction, or disease.1,2

Normal Physiology  In the resting state, anus and rectum are empty and collapsed with their side walls closely approximated. The sigmoid colon, a narrowed segment with relatively high intraluminal pressure, functions as a partial sphincter to retain bowel content in the proximal reservoir of descending colon. Increased intra-abdominal pressure with muscular exertion or straining tends to collapse even more tightly the walls of the empty rectum above the levator muscles to reinforce the mechanisms of continence. In addition, the internal sphincter of the anus maintains a state