Evaluation of Anorectal Disorders

  • Parswa Ansari, Assistant Professor and Program Director in Surgery, Hofstra Northwell-Lenox Hill Hospital, New York

  • MSD Manual
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  • The anal canal begins at the anal verge and ends at the anorectal junction (pectinate line, mucocutaneous junction, dentate line), where there are 8 to 12 anal crypts and 5 to 8 papillae. The canal is lined with anoderm, a continuation of the external skin. The anal canal and adjacent skin are innervated by somatic sensory nerves and are highly susceptible to painful stimuli. Venous drainage from the anal canal occurs through the caval system, but the anorectal junction can drain into both the portal and caval systems. Lymphatics from the anal canal pass to the internal iliac nodes, the posterior vaginal wall, and the inguinal nodes. The venous and lymphatic distributions determine how malignant disease and infection spread.

    The rectum is a continuation of the sigmoid colon beginning at the level of the 3rd sacral vertebra and continuing to the anorectal junction. The rectal lining consists of red, glistening glandular mucosa, which has an autonomic nerve supply and is relatively insensitive to pain. Venous drainage occurs through the portal system. Lymphatic return from the rectum occurs along the superior hemorrhoidal vascular pedicle to the inferior mesenteric and aortic nodes.

    The sphincteric ring encircling the anal canal is composed of the internal sphincter, the central portion of the levators, and components of the external sphincter. Anteriorly, it is more vulnerable to trauma, which can result in incontinence. The puborectalis forms a muscular sling around the rectum for support and assistance in defecation.

    (See also Overview of Foreign Bodies in the GI Tract and Anal Cancer.)

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  • Last modified in -By Parswa Ansari
    Last review 07-2018