{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T12:56:09Z","timestamp":1782305769546,"version":"3.54.5"},"reference-count":16,"publisher":"BMJ","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1977,8]]},"abstract":"<jats:p>Biopsies of the external anal sphincter, puborectalis, and levator ani muscles have been examined in 24 women and one man with long-standing anorectal incontinence, 18 of whom also had rectal prolapse, and in two men with rectal prolapse alone. In 16 of the women anorectal incontinence was of unknown cause, but in eight there was a history of difficult labour. Similar biopsies were examined in six control subjects. In all the incontinent patients there was histological evidence of denervation, which was most prominent in the external anal sphincter muscle biopsies, and least prominent in the levator ani muscles. Myopathic features, which were thought to be secondary, were present in the more abnormal biopsies. There were severe histological abnormalities in small nerves supplying the external anal sphincter muscle in the three cases in which material was available for study. We suggest that idiopathic anorectal incontinence may be the result of denervation of the muscles of the anorectal sling, and of the anal sphincter mechanism. This could result from entrapment or stretch injury of the pudendal or perineal nerves occurring as a consequence of rectal descent induced during repeated defaecation straining, or from injuries to these nerves associated with childbirth.<\/jats:p>","DOI":"10.1136\/gut.18.8.656","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"656-665","source":"Crossref","is-referenced-by-count":451,"title":["Sphincter denervation in anorectal incontinence and rectal prolapse."],"prefix":"10.1136","volume":"18","author":[{"given":"A G","family":"Parks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Swash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Urich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1977,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1001\/archneur.1967.00470190018002","article-title":"Myopathic changes in chronically denervated muscle","volume":"16","author":"Drachman, D.B.; Murphy, S.R.; Nigam, M.P.; Hills, J.R.","year":"1967","unstructured":"Drachman, D. B., Murphy, S. R., Nigam, M. P., and Hills, J. R. (1967). Myopathic changes in chronically denervated muscle. Archives of Neurology, 16, 14-24.","journal-title":"Archives of Neurology"},{"key":"ref_2","article-title":"Muscle Biopsy-a Modern Approach","author":"Dubowitz, V.; Brooke, M.H.","year":"1973","unstructured":"Dubowitz, V., and Brooke, M. H. (1973). Muscle Biopsy-a Modern Approach. Saunders: London."},{"key":"ref_3","first-page":"687","article-title":"Incontinence of urine","volume-title":"Urology","author":"Edwards, L.","year":"1976","unstructured":"Edwards, L. (1976). Incontinence of urine. In Urology, p. 687. Edited by J. Blandy. Blackwell: Oxford."},{"key":"ref_4","first-page":"713","article-title":"Late-onset rod myopathy (a new syndrome?): light and electron microscopic observations in two cases","volume":"41","author":"Engel, A.G.","year":"1966","unstructured":"Engel, A. G. (1966). Late-onset rod myopathy (a new syndrome?): light and electron microscopic observations in two cases. Mayo Clinic Proceedings, 41, 713-741.","journal-title":"Mayo Clinic Proceedings"},{"key":"ref_5","article-title":"'Ragged-red fibres' in ophthalmoplegia syndromes and their differential diagnosis","volume-title":"(Abstract). In Second International Congress on Muscle Diseases, Perth","author":"Engel, W.K.","year":"1971","unstructured":"Engel, W. K. (1971). 'Ragged-red fibres' in ophthalmoplegia syndromes and their differential diagnosis. (Abstract). In Second International Congress on Muscle Diseases, Perth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1136\/jnnp.39.6.566","article-title":"Longitudinal sliding of the median nerve during movements of the upper limb","volume":"39","author":"McLellan, D.L.; Swash, M.","year":"1976","unstructured":"McLellan, D. L., and Swash, M. (1976). Longitudinal sliding of the median nerve during movements of the upper limb. Journal of Neurology, Neurosurgery, and Psychiatry, 39, 566-570.","journal-title":"Journal of Neurology, Neurosurgery, and Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1177\/003591577506801105","article-title":"Anorectal incontinence","volume":"68","author":"Parks, A.G.","year":"1975","unstructured":"Parks, A. G. (1975). Anorectal incontinence. Proceedings of the Royal Society of Medicine, 68, 681-690.","journal-title":"Proceedings of the Royal Society of Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1177\/003591577106401205","article-title":"Late repair of injuries of the anal sphincter","volume":"64","author":"Parks, A.G.; McPartlin, J.F.","year":"1971","unstructured":"Parks, A. G., and McPartlin, J. F. (1971). Late repair of injuries of the anal sphincter. Proceedings of the Royal Society of Medicine, 64, 1187-1189.","journal-title":"Proceedings of the Royal Society of Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1177\/003591576605900601","article-title":"The syndrome of the descending perineum","volume":"59","author":"Parks, A.G.; Porter, N.H.; Hardcastle, J.D.","year":"1966","unstructured":"Parks, A. G., Porter, N. H., and Hardcastle, J. D. (1966). The syndrome of the descending perineum. Proceedings of the Royal Society of Medicine, 59, 477-482.","journal-title":"Proceedings of the Royal Society of Medicine"},{"key":"ref_10","first-page":"379","article-title":"A physiological study of the pelvic floor in rectal prolapse","volume":"31","author":"Porter, N.H.","year":"1962","unstructured":"Porter, N. H. (1962). A physiological study of the pelvic floor in rectal prolapse. Annals of the Royal College of Surgeons ofEngland, 31, 379-404.","journal-title":"Annals of the Royal College of Surgeons ofEngland"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/brain\/99.4.617","article-title":"Longitudinal fibre splitting in neurogenic muscular disorders-its relation to the pathogenesis of 'myopathic' change","volume":"99","author":"Schwartz, M.S.; Sargeant, M.K.; Swash, M.","year":"1976","unstructured":"Schwartz, M. S., Sargeant, M. K., and Swash, M. (1976). Longitudinal fibre splitting in neurogenic muscular disorders-its relation to the pathogenesis of 'myopathic' change. Brain, 99, 617-636.","journal-title":"Brain"},{"key":"ref_12","first-page":"62","article-title":"The mechanical properties of peripheral nerve trunks. In Nerves and Nerve Injuries","author":"Sunderland, S.","year":"1968","unstructured":"Sunderland, S. (1968). The mechanical properties of peripheral nerve trunks. In Nerves and Nerve Injuries, p. 62-66. 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Acta Anatotnica, 30, 946-952.","journal-title":"Acta Anatotnica"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.18.8.656","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T18:59:23Z","timestamp":1763751563000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.18.8.656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1977,8]]},"references-count":16,"journal-issue":{"issue":"8","published-online":{"date-parts":[[1977,8,1]]},"published-print":{"date-parts":[[1977,8]]}},"alternative-id":["10.1136\/gut.18.8.656"],"URL":"https:\/\/doi.org\/10.1136\/gut.18.8.656","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1977,8]]}}}