Defecation

Mahinda Kommalage
ILOs
• Students should be able to
• 1. describe the reflex arc of the defecation.
• 2. describe the control of defecation reflex.
• 3. describe the gastro-colic reflex.
• 4. describe constipation and diarrhea.
Relevancy
• Diarrhea
• Constipation
• irritable bowel syndrome (altered bowel habit in the absence of a
specific and unique organic pathology)
• Defecation is a autonomic spinal reflex that can be
• Voluntarily inhibited by keeping the external sphincter contracted

or

• Facilitated by relaxing the sphincter and contracting the abdominal muscles

sphincters
• Internal anal sphincter –
• Smooth muscle, Involuntary
• Sympathetic nerve is excitatory (contract), parasympathetic supply is
inhibitory (relax)
• This sphincter relaxes when the rectum is distended, we can not control it
• External anal sphincter –
• Skeletal muscle, voluntary
• Pudendal nerve
• Maintained in a state of tonic contraction - usually kept continuously
constricted unless conscious signals inhibit the constriction
• Usually rectum is empty
• Rectal pressure increases with filling
• Urge to defecate first occurs when rectal pressure increases to about
18 mm Hg
• When the pressure reaches 55 mm Hg, both sphincters relax and reflex expulsion of the contents of the
rectum

• However, voluntary we can defecation by straining before this

pressure reach naturally.
GI regulations…… Recall
• Intrinsic properties of the intestinal smooth muscle

• Reflexes involving the neurons intrinsic to GIT

• Reflexes involving the central nervous system (CNS)

• Endocrine effects - Gastrointestinal hormones

• Paracrine effects of chemical messengers
 Defecation reflex
• Myenteric plexus mediated
peristaltic waves in
descending colon, sigmoid,
and rectum. (Intrinsic reflex)

• This move content toward

the anus
• Then strong
parasympathetic defecation
reflex occur that involves the
sacral segments of spinal
code(afferent from mechanoreceptors,
efferent muscles)
 Defecation reflex
• Rectal wall distention
initiates forcing feces toward
the anus.
• As strong contraction wave
approaches the anus, the
internal anal sphincter is
relaxed
 During act
• Defecation reflexes can purposely
be activated by increase the
pressure in the abdomen
• Normally, the angle between the
anus and the rectum is
approximately 90–100° (due to
contraction of the puborectalis
muscle)
• This angle inhibits defecation
 During act
• With straining
• Abdominal muscles contract (pressure
increase, make strong defecation reflex)

• Pelvic floor is lowered 1–3 cm

• Puborectalis muscle relaxes
• Anorectal angle is straightened
(with relaxation of puborectalis muscle), and
when this is combined with
relaxation of the external anal
sphincter, defecation occurs.
• https://www.youtube.com/watch?v=eV4Y2i59ZF0
Gastrocolic reflex
• Distension of the stomach by food initiates contractions of the rectum
• Get desire to defecate

• May be amplified by an action of gastrin on the colon

• Defecation after meals is frequent in children
• Habit and cultural factors play a large role in determining when
defecation occurs in adults
 Diarrhea
• Watery stool due to rapid movement of fecal matter through the large
intestine.
• High osmotically active particle retain water in intestinal lumen
• Due to secretes extra large quantities of water and electrolytes,
increased motility, poor absorption, poor digestion etc
• Enteritis
• Inflammation usually caused either by a virus or by bacteria
• Mucosa becomes irritated with increased rate of secretion and motility of the
intestinal wall usually increases
• Large intestine become inflamed and ulcerated in condition like Ulcerative Colitis.

• Lactose intolerance, acid damage mucosa……

Constipation
• Constipation refers to a pathologic decrease in bowel movements
• Normal - once in every 2–3 days to three times a day
• However, persistent constipation, and particularly those with a recent
change in bowel habits, should be examined to rule out underlying
organic disease such malignancy, hypothyroidism etc.

• Treatment
• diet to include more fiber
• laxatives that retain fluid in the colon, increasing the bulk of the stool and
promoting reflexes that lead to evacuation
• stool lubricant