Internal anal sphincter

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 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]