This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Shafik, A. Articles by Shafik, I. A. Search for Related Content PubMed PubMed Citation Articles by Shafik, A. Articles by Shafik, I. A. Pubmed/NCBI databases Medline Plus Health Information Bowel Movement Social Bookmarking                         What's this?

Contraction of Gluteal Maximus Muscle on Increase of Intra-Abdominal Pressure: Role in the Fecal Continence Mechanism

Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, shafik{at}ahmedshafik.com

Olfat El Sibai, MD, PhD

Department of Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt

Ali A. Shafik

Ismail A. Shafik

The gluteus maximus muscle (GMM) appears to contract with increased intra-abdominal pressure (IAP). The hypothesis that GMM contraction with increased IAP was investigated. The study comprised 32 healthy volunteers. IAP was measured by intravesical catheter. The response of electromyography of the GMM and external anal sphincter to sudden momentary and slow sustained straining was registered. The procedure was repeated after individual urinary bladder and GMM anesthetization. Sudden straining increased electromyographic activity of the external anal sphincter and GMM. Slow, sustained straining raised electromyographic activity of the gluteus maximus and external sphincter at differing degrees depending on straining intensity. The anesthetized gluteus maximus or urinary bladder did not respond to straining. The suggested GMM contraction on straining seems mediated through a reflex that is called "straining-gluteal reflex." This reflex appears to assist anal closure through extended and laterally rotated femur induced by gluteus contraction.

Key Words: straining • anal sphincter • electromyography • femur

References

• Miyazato M., Sugaya K., Nishijima S., et al. Effect of glycerin enema for acute urinary retention in children and its mechanism. J Jpn Med Soc Spinal Cord Lesion. 2003;16:174-178.
• Bleday R., Pena JP, Rothenberger DA, et al. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum. 1992;35:477-480.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Catalds PA, Senagore AJ Does alpha sympathetic blockade prevent urinary retention following anorectal surgery? Dis Colon Rectum. 1991;34:1113-1116.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Bilkey WJ, Awad EA, Smith AD Clinical application of sacral reflex latency. J Urol. 1983;129:1187-1189.[Web of Science][Medline] [Order article via Infotrieve]
• Pedersen E. The anal reflex. In: Swash H, eds. Coloproctology and the Pelvic Floor: Pathophysiology and Management. London, England: Butterworths; 1985: 105-109.
• Shafik A., El-Sibai O. Rectal inhibition by inferior rectal nerve stimulation in dogs: recognition of a new reflex: the "voluntary anorectal inhibition reflex." Eur J Gastroent Hepatol. 2001;13:413-418.
• Denny-Brown D., Robertson EG An investigation of the nervous control of defecation. Brain. 1935;58:256-310.[Free Full Text]
• Shafik A. Straining puborectalis reflex: description and significance of a "new" reflex. Anat Record. 1991;229: 281-284.[CrossRef][Medline] [Order article via Infotrieve]
• Shafik A. Straining-levator reflex: the description of a new reflex and its clinical significance. Coloproctology. 1991;13:314-319.
• Wexner SD, Jorge MN Anatomy and embryology of the anus, rectum and colon. In: Corman ML, ed. Colon and Rectal Surgery. 4th ed. New York, NY: Lippincott Raven; 1998:1-26.
• Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: I: the external anal sphincter: a triple loop system. Invest Urol. 1975;12:412-419.[Web of Science][Medline] [Order article via Infotrieve]
• McMinn RMH. Gluteal region and hip joint. In: McMinn RMH, ed. Last's Anatomy. Regional and Applied. 8th ed. Edinburgh, UK: Churchill Livingstone; 1990:161-172.
• Goligher J., Duthie H., Nixon H. Megacolon and idiopathic constipation in adults. In: Goligher J, Duthie H, Nixon H, eds. Surgery of the Anus, Rectum and Colon. 5th ed. London, England: Balliere Tindall; 1984:335-345.
• Yokoyami O., Komatso K., Kodama K., et al. Diagnostic value of intravesical lidocaine for overactive bladder. J Urol. 2000;164:340-343.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Silva C., Ribeiro MI, Cruz F. The effect of intravesical resiniferatoxin in patients with idiopathic detrusor instability suggests that involuntary detrusor contractions are triggered by C-fiber input. J Urol. 2002;168:575-579.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

Surgical Innovation, Vol. 14, No. 4, 270-274 (2007)
DOI: 10.1177/1553350607312516


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Shafik, A. Articles by Shafik, I. A. Search for Related Content PubMed PubMed Citation Articles by Shafik, A. Articles by Shafik, I. A. Pubmed/NCBI databases Medline Plus Health Information Bowel Movement Social Bookmarking                         What's this?