9/20/2019 Anal Canal - parts, internal features sphincters, blood and nerve supply -

Anal Canal  / Anal Canal

/  Anatomy, Pelvis and Perineum

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CONTENTS [hide]

1 What are the boundaries of Perineum?

2 What are the subdivisions of perineum and their contents?
3 Describe the extent, location of anal canal.
4 What are the relations of anal canal?
5 What are parts of anal canal ?
6 What are the differences between the upper and lower parts of anal canal?
7 Describe the internal features of different parts of anal canal.
8 Describe briefly the sphinters and the longitudinal coat of muscle of anal canal.
9 Describe in brief the arterial supply of Anal canal.
10 Describe the venous drainage of anal canal.
11 Applied Aspects
11.1 Haemorrhoids/Piles
11.1.1 Internal haemorrhoids
11.1.2 External haemorrhoids
11.2 Fissure -in-ano
11.3 Perianal abscesses
11.4 Anal fistula
11.5 Share this:
11.6 Related
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What are the boundaries of Perineum?

Perineum is the diamond-shaped lowest region of trunk below the pelvic

diaphragm.

The skeletal and ligamentous boundaries of perineum correspond to those

of pelvic outlet.

Anteriorly: Lower border

of pubic symphysis.
Anterolaterally:
Ischiopubic rami.
Laterally: Ischial
tuberosities.
Posterolaterally:
Sacrotuberous ligaments.
Posteriorly: Tip of coccyx.

What are the subdivisions of perineum and their contents?

An imaginary transverse line joining the anterior ends of ischial tuberosities

divides the Perineum into two triangles:

Urogenital triangle anteriorly: Mainly contains

external genitalia, part of urethra and superficial
and deep perineal pouches with their contents.
Anal triangle posteriorly: Mainly contains anal
canal in the center and ischiorectal fossae on either
side.

Describe the extent, location of anal canal.

Extent of Anal canal

Anal canal is the terminal part of large intestine.

It lis located in the center of the anal triangle of perineum below the pelvic
diaphragm.
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It is 3-4cm long and is directed downwards and backwards from the rectum.
Anus is its external opening.
It is devoid of sacculations, tenea coli and appendices epiploicae.

What are the relations of anal canal?

Anteriorly: perineal body

Posteriorly: anococcygel ligament.
Laterally: Ischiorectal fossae.

What are parts of anal canal ?

Interior of anal canal is divided into upper and lower parts by the
pectinate line. The lower part is further divided into upper and lower
regions by Hilton’s line.
Pectinate line is the site of attachment of the anal membrane in fetus.
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The upper and lower parts of anal canal are different in development , blood and
nerve supply, and lymphatic drainage

What are the differences between the upper and lower parts of anal
canal?

[table id=52 /]</div>

Describe the internal features of different parts of anal canal.

Upper part of anal canal

It is 15mm long.
It extends from anorectal junction to pectinate line.
It is lined by simple columnar epithelium.
It is reddish in colour and shows following features:
Anal columns/Columns of Morgagni: These are 6-10 permanent vertical
mucosal folds. Each fold contains terminal radicles of superior rectal vessels.
Anal valves : Are semilunar shaped transverse mucosal folds which
connect the lower end of the anal columns. Free margins of the valves are
directed upwards. The wavy pectinate or dentate line lies at this level.
Anal sinuses:Are the vertical recesses between the anal columns and
above the anal valves.

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Upper region of Lower Part of Anal canal (Pecten)

Is 15mm long and extends from pectinate line to Hilton’s line. The white
line of Hilton demarcates mucocutaneous junction and corresponds to the
intersphincteric groove ( lower end of internal sphincter muscle).
It is lined by stratified squamous non-keratinized epithelium.
It .is bluis in colour due to the presence of venous plexus underneath.

Lower Region of Lower Part of Anal Canal

It is 8mm long and lies below Hilton’s line.

Is lined by skin (stratified squamos keratined epithelium)
containing sebaceous and sweat glands.
It is black in clour.

Describe briefly the sphinters and the longitudinal coat of muscle

of anal canal.

There are two sphincters of anal canal:

Internal sphincter
External sphincter

Internal anal sphincter

Is formed by thickening of circular muscle coat of anal canal. 

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It surrounds the upper 2/3rd of anal canal.

It ends at the level of Holton’s line.
Is made up of smooth muscle and is under control of autonomic nerves and
hence is involuntary.
Is surrounded by deep and superficial parts of external anal sphincter.

External anal sphincter

It surrounds the whole length of anal canal.

It is made up of skeletal muscle and is innervated by somatic nerve inferior
rectal nerve) and therefore has voluntary control.
It consists of three parts
deep
superficial
subcutaneous
Deep part of external anal sphincter:
Surrounds the upper part of anal canal.
Has no bony attacment.
Puborectalis part of levator ani blends with this part of external anal
sphincter.
Superficial part of external anal sphincter
It surrounds the lower part of internal anal sphincter. 
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It arises from the tip of the coccyx and anococcygeal ligament and is
inserted into the perineal body.
Is elliptical in shape.
Subcutaneous part of External anal sphincter
It lies below the level of internal anal sphincter.
It has no bony attachment.
It is traversed by fibroblastic septa derived from the conjoint
longitudinal muscle coat of anal canal.

Longitudinal muscle of the anal canal

Longitudinal muscle of the anal canal separates the internal anal
sphincter from the external anal sphincter.
It Fuses with part of puborectalis muscle to form the conjoint
longitudinal sheet.
It becomes progressively fibroelastic and breaks into number of fibrous
strands which pass through the subcutaneous part of external anal
sphincter and attach to the skin around the anus.

Describe in brief the arterial supply of Anal canal.

Anal canal is supplied by the following two arteries:

Superior rectal artery::Is a branch of inferior mesenteric artery. Its

branches form submucosal plexus which extends as terminal radicals in the
anal columns.It supplies the mucosa of the anal canal above the pectinate
line.
Inferior rectal artery: Is a branch of internal pudendal
artery. It supplies the mucosa of the anal canal below the pectinate line.

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Describe the venous drainage of anal canal.

Above the pectinate line: Is drained by the internal venous plexus into
the superior rectal vein which drains ultimately into the portal circulation.
Below the pectinate line: Is drained by inferior rectal vein, a tributary of
systemic vein.

Applied Aspects
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Haemorrhoids/Piles

The haemorrhoids are of two types:

Internal haemorrhoids
External haemorrhoids

Internal haemorrhoids

Are the dilatations of radiclels/tributaries of superior rectal vein in the

submucosa of anal canal above the pectinate line. Each haemorroid consists
of a mucosal and submucosal fold containing a varicose radicle of superior
rectal vein and a terminal branch of superior rectal artery. As upper part of
anal canal is the site of porto-caval anastomosis, the internal haemorrhoids
may develop due to portal hypertension/portal vein obstruction.

a. Primary Internal Haemorrhoids: The terminal radicles of superior

rectal vessels are well developed in the left lateral (3O’clock) position, right
posterior ( 7O’clock) position and right anterior (11O’clock) position ( when
patient is examined in the lithotomy position) hence haemorrhoids
(varicosity of veins in this region) are common at these three sites and are
called primary haemorrhoids.

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b. Secondary Internal Haemorrhoids: Dilatation of radicles of

superior rectal vein at other positions are called secondary haemorrhoids.

As these haemorrhoids develop above the pectinate line, they are

painless (this region is supplied by autonomic nerves).

Another way of classifying internal haemorrhoids is :

1st degree haemorrhoids: they remain confine to anal canal.

2nd degree haemorrhoids: they enlarge and prolapse during
defection.
3rd degree haemorrhoids: remain prolapsed.

External haemorrhoids

These are dilatations of tributaries of inferior rectal vein. They develop

below the pectinate line and are painful ( this region is supplied by somatic
nerve).

Fissure -in-ano

It is a tear in one of the anal valves due to passage of hard faeces. It usually
occurs posteriorly in the midline. Usually involves only the epithelium and,
in the long term, involves the full thickness of the anal mucosa. It is very
painful as inferior aspect of the anal valves is supplied by somatic nerves.

Perianal abscesses

Is an infected cavity filled with pus found near the anus.Are classified by
their location:

a. perianal b. ischioanal c. intersphincteric

d. supralevator

The perianal area is the most frequent and the supralevator the least.

Anal fistula
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A fistula-in-ano is an abnormal hollow tract lined by epithelium that

connects an opening inside the anal canal to an opening in the perianal
skin. Usually results from rupture of an abscess (an infected cavity filled
with pus) around the anal canal. Fistulas are classified by their relationship
to parts of the anal sphincter complex They are classified as :

a. intersphincteric b. transsphincteric c. suprasphincteric

d. extrasphincteric

The intersphincteric is the most common and the extrasphincteric is the

least common.

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