Dr.

Nabarun Biswas
Indoor Medical Officer
Surgery Unit -2, MMCH
Anus & Anal Canal

• It is the
lowest part of
GIT that
begins at the
level where
the rectum
passes
through the
pelvic
diaphragm &
ends at the
anal verge
Embryology
Interior
Interior in detail
Musculature
Pubo-rectalis muscle
Sphincters of anus
Rectum
 Location and peritoneal relations of
the rectum

S3

1 inch infront of
coccyx
 Shape (flexures) of the rectum

- Antero-posterior curve
- 3 flexures
1. Upper concave to left
2. lower concave to left
3. Middle concave to right

Rectal ampulla
Anterior relations of the rectum
Posterior relations of the rectum
Arterial supply of ano-rectum
Venous
drainage
 Hemorrhoids

Internal hemorrhoids
•Tributary of sup rectal
•Above dentet line
•Generally painless

External hemorrhoids
•Tributary of inf rectal
•Below white line
•Generally painful
11 o’clock

3 o’clock
7 o’clock
Lymphatic drainage of anus
Lymphatic drainage of rectum
 Nerve supply of the anus

•  Pudendal nerve (S2-4)

•  Sensory; internal pudendal
•  Motor
• Internal sphincter; sympathetic &
parasympathetic
• External sphincter; inferior rectal
branch of internal pudendal n,
perineal branch of S4
Nerve supply of the rectum

•  Sympathetic L1-3
•  Parasympathetic S2-4
•  The hypogastric plexus
•  Pelvic plexus
Nerve supply
Physiology of defecation

• It is the final act of digestion by which

body eliminate solid, semisolid or liquid
waste material from digestive tract.

• Sensation: receptive relaxation of the

rectum, anal sampling, recto-anal reflex

•  Center: S2-4, cortical

• Effectors: sphincters, rectal contraction,

abdominal muscles, levator ani
Defecation
 Continence mechanism

1. Internal sphincter; involuntary, resting

tone
2. External sphincter; voluntary, squeeze
pressure
3. Levator ani
4. Anorectal angle
5. Anal cushions