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The external anal sphincter is the ring of skeletal muscle surrounding the distal anal canal. Its contraction helps maintain faecal continence; its motor neurons allow voluntary squeezing as well as reflex control. It works alongside the smooth muscle of the internal anal sphincter, so continence depends on coordinated structures rather than one isolated ring.^[ref]

Branches of the pudendal nerve supply the external anal sphincter. Dissection of 28 cadavers found a local nerve plexus near the sphincters in five, illustrating why a schematic nerve route need not capture every individual's branching. Preserving muscle alone therefore does not guarantee preservation of its motor supply.^[ref]

The internal anal sphincter is a ring of smooth muscle at the lower end of the rectum and around the upper anal canal. It contributes involuntary resting closure. The surrounding external anal sphincter is a different muscle system with voluntary control, so the two should not be treated as one anatomical ring.^[ref]

Rectal distension can trigger relaxation of the internal anal sphincter, the rectoanal inhibitory reflex. Researchers can inflate a rectal balloon while recording anal pressure, separating this relaxation from other contractile responses and from reported sensation. A study of 23 subjects observed inhibitory and contractile reflexes during graded balloon distension.^[ref] A continuous pressure trace therefore reveals coordinated components of continence that are difficult to infer from static anatomy alone.

The pudendal nerve is a mixed nerve of the sacral plexus, usually receiving fibers associated with S2–S4 spinal nerves. It carries sensory information from much of the perineum and motor signals to skeletal muscles involved in continence, including the external anal sphincter and external urethral sphincter. Its route includes the pudendal canal.

A description of anatomy is a pattern with variation, not a guarantee that every individual has identical branching. Dissection of 28 cadavers documented additional branches and interconnections near the external anal sphincter in some specimens.^[ref] The study also illustrates the difference between a skeletal muscle being structurally intact and its nerve supply being intact: coordinated contraction depends on both the skeletal muscle and the arriving motor signals.

The rectoanal inhibitory reflex is relaxation of the internal anal sphincter in response to distension of the rectum. Because the internal anal sphincter is smooth muscle, this relaxation is distinct from voluntary control of the external anal sphincter. In manometry, a rectal balloon supplies a controlled distension while anal pressure sensors record the response over time.^[ref]

A fall in pressure can coexist with a contractile response elsewhere or at another time. The same study measured inhibitory and contractile reflexes and asked subjects about sensation; a relaxation trace therefore cannot simply be equated with the conscious urge to empty the rectum.^[ref]

A complementary experiment recorded tension in isolated human internal anal sphincter strips. A donor of nitric oxide relaxed the strips; blocking its synthesis suppressed relaxation evoked by electrical nerve stimulation, and arginine reversed the inhibition in a stereospecific control. These interventions support a role for nitric oxide in nerve-mediated relaxation. An isolated strip identifies a mechanism in the effector muscle; it does not reproduce the whole intact reflex circuit.^[ref]

Steven E. Schraffordt led a dissection study of the pudendal nerve and its terminal branches. Examination of 28 cadavers documented variations relevant to the motor supply of the external anal sphincter. In five specimens, interconnecting inferior rectal and perineal branches formed a local nerve plexus near the sphincters.^[ref]

This is a practical contribution of anatomical observation: an intact muscle can lose function if its nerve supply is injured. A schematic branching pattern therefore needs to be interpreted alongside documented variation when considering pelvic anatomy.