Paralysis of the anal sphincters occurs frequently in consequence of long-lasting affections of the rectum. Sometimes over-exertion of these muscles (tenesmus) ultimately leads to exhaustion. Occasionally ulcerations and infiltrations of the rectum involve also the sphincters or entirely destroy them, thus annulling their functions. The tonicity of the sphincter muscles may be imputed in persons who have suffered for a long time from an accumulation of fecal matter in the lower portions of the bowel. The muscular apparatus being over-irritated for a long time becomes weakened and exhausted. Diseases of the brain and spinal cord, leading to inhibition of the will power, may likewise cause paralysis of the sphincters.

Atony, paresis, and paralysis form different degrees of this affection. Some patients are not able to keep the rectum tightly closed, and a small amount of secretion continually penetrates through the anus. After defecation they have the sensation of not having finished the act. Sometimes there may be an involuntary movement of the bowels in consequence of the loss of the contractile power. This, however, occurs only after strong excitement, intense bodily exertion, during urination, and rarely in walking.

In case the paralysis of the sphincters is complete, flatus and fecal matter will escape involuntarily even in a state of rest. In paralysis resulting from proctitis, hemorrhoids, stricture, etc., there is a continuous dripping of a muco-sanguinary secretion which greatly irritates the skin surrounding the anus.

Diagnosis

Paralysis of the anal sphincter can be recognized very easily. The anus appears patulous and the anal folds have disappeared. Two and even three fingers may be introduced into the rectum without encountering any resistance. In making the diagnosis of a purelv nervous paralysis anatomical lesions must first be excluded. This is done by means of a thorough examination of the rectum with a speculum.

Prognosis

Paralysis resulting from anatomical lesions of the rectum gives an unfavorable prognosis. In the purely neurotic form, however, the prognosis is much better.

Treatment

It is of great importance to secure a thorough evacuation of the bowels, which is best done by rectal injections of water twice daily. Paralysis due to fecal impaction as such, can be entirely remedied by the just mentioned measures alone. Thus Wallace 1 reports a cure in a case of a nine-year-old boy who was troubled for three years with incontinency of faeces, which dropped out whenever he walked. The patient was treated with water enemas to which castor oil had been added, and later on with injections of water with the addition of alum. After a month's treatment he entirely recovered.

In paralysis due to affections of the central nervous system electricity and massage may be of benefit. Hypodermic injections of strychnine (0.001 to 0.0015 pro dose) into the anal folds have been recommended by Rosenheim. Cases in which the paresis of the sphincter is due to a difficulty in urination and a continuous straining in order to void the bladder, the paresis will be improved by artificially emptying the bladder by means of a catheter for a considerable length of time.