DEFECATION REFLEX

Postgraduate Trainees

Islamic International Medical College

 SCENARIO

• A 65 year old male presented to surgical specialist

with complaints of generalized weakness and
dribbling of fecal content. Patient gave history of
road traffic accident few days in which he was hit
by a bike at lower region of his back.

What do you think is underlying cause for

dribbling of fecal content ?
 QUESTIONS

• How normal content of colon is prevented from

passing through the anus?

• How is the internal anal sphincter controlled?

• How is the external anal sphincter controlled?

• What are the changes that occur during process of

defecation?
 LEARNING OBJECTIVES

By end of discussion, postgraduate trainees should

be able to:

• Define defecation reflex

• Describe the events and control of defecation

reflex
 DEFECATION

“Process of removing undigested food materials

(faeces) out of the body through the anus”
 DEFECATION
• Rectum is empty of feces
most of time:

 Presence of a weak
functional sphincter
present at 20 centimeters
from anus at juncture
between sigmoid colon
and rectum
 DEFECATION
• Rectum is empty of feces
most of time:

 Sharp angle between

sigmoid colon and
rectum that contributes
additional resistance to
filling of the rectum
 OVERVIEW OF DEFECATION

Mass movement in intestine

Forces feces

Rectum

Desire for defecation occurs

Relaxation of Reflex contraction

anal sphincters of rectum
 PREVENTION OF CONTINUAL DRIBBLE OF
FECAL MATTER THROUGH ANUS
• By tonic constriction of:

 An internal anal
sphincter, a several-
centimeters-long
thickening of circular
smooth muscle that lies
immediately inside anus
 PREVENTION OF CONTINUAL DRIBBLE OF
FECAL MATTER THROUGH ANUS
• By tonic constriction of:

 An external anal
sphincter, composed of
striated voluntary muscle
that both surrounds
internal sphincter and
extends distal to it
 INTERNAL ANAL SPHINCTER
• Involuntary

• Sympathetic nerve
supply is excitatory

• Parasympathetic supply
is inhibitory

• Sphincter relaxes when

rectum is distended
 EXTERNAL ANAL SPHINCTER
• Voluntary

• Controlled by nerve fibers in

pudendal nerve(somatic)

• Subconsciously, external
sphincter is usually kept
continuously constricted
unless conscious signals
inhibit the constriction
RECTUM UNDER RESTING CONDITION
 DEFECATION REFLEX

• Defecation is initiated by defecation reflexes:

1. An intrinsic reflex 2. Parasympathetic

mediated by the defecation reflex
local enteric that involves the
nervous system in sacral segments of
the rectal wall the spinal cord
 INTRINSIC REFLEX

• Weak reflex

• Stimulus = distension of rectum

• Receptors = stretch receptors in rectum

• Integration in myenteric plexus

• Response = contraction of descending colon,

sigmoid and rectum, relaxation of internal
anal sphincter
18
 Entrance of feces in rectum
Distention of the rectal wall
Initiation of afferent signals in myenteric plexus
Spread through the myenteric plexus
Initiation of peristaltic waves in descending colon, sigmoid, and
rectum
External anal sphincter is also consciously, voluntarily relaxed at
the same time
Internal anal sphincter is relaxed by inhibitory signals from the
myenteric plexus
Forcing feces toward the anus
Defecation
 PARASYMPATHETIC REFLEX

• Stronger reflex (fortifies the intrinsic reflex)

• Stimulus = distension of rectum

• Receptors = stretch receptors in rectum

• Afferent fibers to spinal cord

• Integration in sacral segment of spinal cord

 PARASYMPATHETIC REFLEX

• Efferent parasympathetic nerves to

descending colon, sigmoid and rectum

• Response = contraction of descending colon,

sigmoid and rectum; relaxation of internal
anal sphincter
 Entrance of feces in rectum
Distention of the rectal wall
Nerve endings in the rectum are stimulated
Signals transmitted to sacral segment of spinal cord
Parasympathetic nerve fibers in pelvic nerves
Signals reflexly back to descending colon, sigmoid, rectum, and
anus
Converting intrinsic myenteric defecation reflex from weak effort
into a powerful process of defecation
Parasympathetic signals greatly intensify peristaltic waves and
relax internal anal sphincter
Defecation
 Physical effects during defecation

 Lowering the pelvic floor

 Flattening of anorectal angle

 Relaxation of puborectalis muscle

 DEFECATION

• Physical effects during defecation:

 Deep breath

 Closure of glottis

 Contraction of abdominal muscles

All the three factors(valsalva maneuver)

increase intra-abdominal pressure which helps
in expelling the feces
 GASTROCOLIC AND
DUODENOCOLIC REFLEX
 Gastrocolic reflex

• Distention of the stomach by food initiates contractions of

the rectum and, frequently, a desire to defecate

• It may be amplified by the action of gastrin on the colon

SUMMARY OF EVENTS
OCCURING DURING
DEFECATION
 Mass movement of
intestinal content
Rectal pressure increases
to 18 mmHg
Urge to defecate occurs
for first time
Pressure reaches 55 mmHg
External and internal
sphincter relaxes
Reflex expulsion of
rectal contents
DEFECATION
Straining
Initiation of voluntary defecation
Contraction of
Abdominal muscles
Relaxation of Puborectalis
muscle
Pelvic floor is lowered 1–3 cm
Anorectal angle is reduced from
90o to 15o