Dr.Bhat.A.Rangaprasad -Sarve janah Sukhino Bhavanthu || Sarve santhu Niramayah ||
Could there possibly be a way, sans medication, to ease the difficulty of straining oneself during defecation?
The above question started haunting my mind some 2 years back, when I thought for some possible solution in easing my clients from straining themselves during the defecation of a constipated bowel.
Because, in cases of hemorrhoids or piles (non bleeding variety), straining during defecation causes increase in intra abdominal pressure, which in turn increases the local congestion in the hemorrhoidal vein,thus making it get bulges further more resulting in it's rupture and ending up as a bleeding piles.
Being oriented with the subject of anatomy during my stint as a faculty, I was contemplating for a cue with regards to modulating or modifying or stimulating the action of the anal sphincters via some remote muscular movements.
The external anal sphincter has its origin from perineal body or central tendinous point of the perineum and further gets inserted by encircling along the anal canal.Their superficial fibers attach to the coccyx.
The main action of the external sphincter is to constrict the anal canal.
The origin of anal sphincter externa from the perineal body, note worthily,caught my attention.
What if the skin around the perineum was by some means made to stretch in either of the sides, so that the external sphincter too gets stretched as accordingly, there by paving a mechanical advantage of pushing down the hardened fecal matter with out any undue strain or pushing down by increasing the intra abdominal pressure.
The above vague thought which crossed my mind, could not be brushed aside as a silly thought, hence I took some serious interest in further divulging into the core of the matter.
And while in a deep thought, got a cue regarding the vertebral muscle and in specific the erector spinae muscle,to say.
The erector spinae gets originated from -
transverse and spinous processes of vertebrae
Further more it gets inserted up on
angles of the ribs,
transverse and spinous processes of vertebrae
posterior aspect of the skull.
The principal action of the erector spinae are supposed to be that it extends and laterally bends the trunk, neck and head.
While speaking about the erector spinae which extends the spine, mention about the rectus abdominis muscle could not be neglected, since they are antagonistic in action to that of the erector spinae.These muscle groups work in concert to flex and extend the trunk. In back extensions, a strong rectus abdominis muscle balances the muscle actions of the erector spinae as they extend the trunk, there by maintaining an equilibruim between the two in enforcing proper protection to the lower back from not getting injured or insulted.
The rectus abdominis is a long flat strip of muscle that stretches from just below the sternum down to the pubic bone. The main function of the rectus abdominis is to flex the vertebral trunk in such actions as bending forward from the hips. The rectus abdominis also plays a role in expelling mucus or foreign particles from the lungs and throat, giving birth, defecating and boosting pressure within the abdominal cavity.
Basically having related the topic under discussion to these two muscles, the modulation of the muscular movement in relaxing the anal sphincter has to be thought of. It is a fact that the erector spinae is related to the perineum and that the anus is in proximity to the perineum. Hence, by common sense, if we enhance some sort of stretching of the skin over the perineum, it probably would have an indirect effect of mild stretching over the external sphincter.
But, how to create such an episode of stretching to happen over there with erector spinae, whose function is just erecting the spine?
It is to be understood that when standing erect the erector spinae will be in a relaxed and composed state. But for our primary object of the experiment or study, it should be held in a position of over stretching or it should be kept active in it's maximum limit. Only when we flex or bend our entire spine forwards or when we bend our body laterally (in erect state of spine and not in flexed state of spine), one would feel the complete stretch of the erector spinae in their maximum limit.
By doing so, the skin all along the entire back gets stretched from up down wards(specifically when bent forward) and further more gets stretched over sides of the perineum (with specificity to lateral bending of the spine).
Keeping the above concept of observation in mind, I started advising and advocating my clients when at strain during defecation to bend their spine forwards to their maximum limit for 2 seconds followed by left lateral bending for 2 seconds followed by right lateral bending for another two seconds.The method can be adopted in both eastern/ squat toilets & western/ sitting toilets.
They were further instructed to note & report, the level of ease of passing the bowels happening at which particular bending.
As per the collective reports obtained from my clients, I understood, that contra lateral bending relaxes the sphincter, with relation to the area of obstructed feces. I mean, if the person feels some sort of heaviness or pain or stiffness along the right portion of sphincter, then left bending eases the bowel movement and like wise if obstructed in left of sphincter the right lateral bending relaxes the structure.
Like wise if the obstruction is over the posterior or back of the sphincter the forward bending eases like wise if obstructed in front or anterior aspect then back ward bending.
There is another point observed by the clients that, they feel the accumulated gas/flatus (present in between the fecal mass) gets released first followed by some bowel movement which they hear with a feeble but fast sound (probably they are referring to the peristaltic wave). And the feel that the gas passes from the area of congestion or obstruction caused by the fecal mass.
In all those clients, who helped me in the above study, the medication in the form of laxative were gradually tapered and stopped, once we felt that they have mastered in the art of relaxing their sphincters.
The criteria for inclusion of the above study was persons of the age group between 45 to 70 years of age and those who had been suffering from Obstinate Constipation, Piles (both bleeding & non bleeding), IBS & Anal fissures.
The above study was a random one, and not a planned study, hence proper figures could not be prepared.
Hope, this write up of mine paves way to any P.G or research scholars of Anatomy or Proctology,in pursuing the methodological research, if interested.
Sarve santhu niramaya: ||
Sarve janaa: sukhino bhavanthu: ||