Anal Vagina Band

Anal Vagina Band

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Synonyms:
Superior rectal artery, Superior hemorroidal artery
,
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Author:
Achudhan Karunaharamoorthy
•

Reviewer:
Dimitrios Mytilinaios MD, PhD

Last reviewed: October 14, 2022

Reading time: 8 minutes

The anal canal is the last part of the gastrointestinal tract . It is about 3 to 4 cm long and lies completely extraperitoneally . It begins at the anorectal junction distally from the perineal flexure and ends at the anus.
It is divided into three anatomical zones; columnar, intermediate and cutaneous. The dentate (pectinate) line divides the anal canal into upper (two-thirds) and lower (one-third) parts, each one being supplied by completely different neurovascular structures. The functions of the anal canal include the maintenance of fecal continence and defecation . This is achieved with the help of the anal sphincters and the neighbouring puborectalis muscle.
This article will describe the anatomy and function of the anal canal.
The anal canal may be subdivided into the columnar, intermediate and cutaneous zone.
The columnar zone derives from the endoderm whereas both the intermediate and cutaneous zone develop from the proctodeum (cloaca). As a result of the different embryologic origins, the zones have separate supplying structures. Hereby the dentate line serves as an important marker.
The arterial blood is supplied by the superior rectal artery (branch of the inferior mesenteric artery). The venous blood flows through the internal hemorrhoidal plexus into the superior rectal vein (→hepatic portal system). The lymph drains into the lumbar (paraaortic) lymph nodes. The sympathetic innervation is carried by the inferior mesenteric plexus , while the parasympathetic innervation by the pelvic splanchnic nerves and the inferior hypogastric plexus .
The blood supply comes from the middle (branch of the internal iliac artery) and inferior rectal arteries (branch of the pudendal artery from the internal iliac artery). The venous blood drains via the external hemorrhoidal plexus into the middle and inferior rectal veins (→body circulation). The lymph flows into the inguinal lymph nodes . The pudendal nerve is responsible for the sensory innervation.
For more details about the anal canal, take a look at the videos, articles, illustrations and quizzes in the following study unit:
In the anal canal the intestinal mucosa (colorectal zone) changes to anal mucosa (anoderm) through a transitional zone and finally merges with the perianal skin (cutaneous zone).
The anal canal is an important part of the continence organ. It is surrounded by a muscular sphincter system which tightly closes the lumen. The internal anal sphincter is permanently contracted through the sympathetic tonus and relaxes under parasympathetic influence. The external anal sphincter surrounds the anal canal like a clamp. It is in close relationship to the puborectalis muscle (part of levator ani muscle ) which encircles the rectum from behind (puborectal sling) and thus forms a bending closure. Both the external anal sphincter and the puborectalis muscle are voluntarily controlled.
The anal canal is only one component of the gastrointestinal tract. Is your knowledge of the rest of the digestive system up to scratch? Find out with our free digestive system quizzes and learning tools.
The anal cushions play an important role in the fine control. Physiologically they are filled with arterial blood. During defecation, the internal anal sphincter relaxes so that the blood in the cushions drains away, allowing a smooth passage of the stool through the anal canal. A pathological enlargement of the anal cushions leads to hemorrhoids.
The human anal glands are rudimentary. Their secreted scent does not a play role for humans anymore. For many animals the scent still fulfills important functions, e.g. territory marking or sexual stimulation.
Now that you've learned everything about the anal canal, why not put that knowledge to the test with the quiz below!
The anal canal is the last part of the gastrointestinal tract. It is about 3 to 4 cm long and lies completely extraperitoneally. It begins at the anorectal junction distally from the perineal flexure and ends at the anus. Overall, it is an important part of the continence organ. Anatomically it is subdivided into three zones:
The blood supply, innervation and lymphatic drainage is influenced by the dentate line.
Histologically, the anal canal consists of the following zones:

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Extraperitoneal, between the anorectal junction and anus

Columnar zone - anal columns, anal cushoins, anal valves, crypts of Morgagni, dentate (pectinate) line

Intermediate zone - anoderm

Cutaneous zone - perianal skin

Above dentate line.(superior 2/3) - superior rectal artery

Below dentate line (inferior 1/3) - middle and inferior rectal arteries

Above dentate line.(superior 2/3) - superior rectal vein followed by hepatic portal circulation

Below dentate line (inferior 1/3) - middle and inferior rectal veins followed by the vena cava circulation

Above dentate line.(superior 2/3) - inferior mesenteric plexus, pelvic splanchnic nerves, inferior hypogastric plexus

Below dentate line (inferior 1/3) - pudendal nerve

Colorectal zone - simple columnar epithelium

Transitional zone - simple columnar and stratified squamous epithelium

Anoderm - stratified squamous non-keratinized epithelium

Cutaneous zone - stratified squamous keratinized epithelium

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Journal List

World J Gastroenterol

v.15(24); 2009 Jun 28

PMC2702115

World J Gastroenterol. 2009 Jun 28; 15(24): 3051–3054.
Published online 2009 Jun 28. doi: 10.3748/wjg.15.3051
Jin Liu, Li-Dong Zhai, Yun-Sheng Li, Wan-Xiang Liu, Department of Anatomy and Neurobiology, Tianjian Medical University, Tianjin 300070, China
Rui-Hua Wang, Radiology Division, Tianjin Hongqiao Hospital, Tianjin 300131, China
Received 2009 Mar 3; Revised 2009 May 7; Accepted 2009 May 14.
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
Keywords: Measurement, Space, Rectocele, Computed tomography
1. Nichols DH, Genadry RR. Pelvic relaxation of the posterior compartment. Curr Opin Obstet Gynecol. 1993; 5 :458–464. [ PubMed ] [ Google Scholar ]
2. Pucciani F, Rottoli ML, Bologna A, Buri M, Cianchi F, Pagliai P, Cortesini C. Anterior rectocele and anorectal dysfunction. Int J Colorectal Dis. 1996; 11 :1–9. [ PubMed ] [ Google Scholar ]
3. D'Avolio M, Ferrara A, Chimenti C. Transanal rectocele repair using EndoGIA: short-term results of a prospective study. Tech Coloproctol. 2005; 9 :108–114. [ PubMed ] [ Google Scholar ]
4. Ayabaca SM, Zbar AP, Pescatori M. Anal continence after rectocele repair. Dis Colon Rectum. 2002; 45 :63–69. [ PubMed ] [ Google Scholar ]
5. Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M. Rectocele: pathogenesis and surgical management. Int J Colorectal Dis. 2003; 18 :369–384. [ PubMed ] [ Google Scholar ]
6. Heriot AG, Skull A, Kumar D. Functional and physiological outcome following transanal repair of rectocele. Br J Surg. 2004; 91 :1340–1344. [ PubMed ] [ Google Scholar ]
7. D'Hoore A, Vanbeckevoort D, Penninckx F. Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg. 2008; 95 :1264–1272. [ PubMed ] [ Google Scholar ]
8. Reisenauer C, Huebner M, Wallwiener D. The repair of rectovaginal fistulas using a bulbocavernosus muscle-fat flap. Arch Gynecol Obstet. 2009; 279 :919–922. [ PubMed ] [ Google Scholar ]
9. Tantanasis T, Giannoulis C, Daniilidis A, Papathanasiou K, Loufopoulos A, Tzafettas J. Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence? Hippokratia. 2008; 12 :108–112. [ PMC free article ] [ PubMed ] [ Google Scholar ]
10. Nichols DH, Milley PS. Identification of pubourethral ligaments and their role in transvaginal surgical correction of stress incontinence. Am J Obstet Gynecol. 1973; 115 :123–128. [ PubMed ] [ Google Scholar ]
11. Delancey JO, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008; 199 :610.e1–610.e5. [ PMC free article ] [ PubMed ] [ Google Scholar ]
12. DeLancey JO. Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol. 1999; 180 :815–823. [ PubMed ] [ Google Scholar ]
13. Porter WE, Steele A, Walsh P, Kohli N, Karram MM. The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol. 1999; 181 :1353–1358; discussion 1358-1359. [ PubMed ] [ Google Scholar ]
14. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut. 1989; 30 :1737–1749. [ PMC free article ] [ PubMed ] [ Google Scholar ]
15. Guarnieri A, Cesaretti M, Tirone A, Vuolo G, Verre L, Savelli V, Piccolomini A, Di Cosmo L, Carli AF, Burroni M, et al. [Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience] Chir Ital. 2008; 60 :243–248. [ PubMed ] [ Google Scholar ]
16. Yamana T, Takahashi T, Iwadare J. Clinical and physiologic outcomes after transvaginal rectocele repair. Dis Colon Rectum. 2006; 49 :661–667. [ PubMed ] [ Google Scholar ]
17. Sullivan ES, Leaverton GH, Hardwick CE. Transrectal perineal repair: an adjunct to improved function after anorectal surgery. Dis Colon Rectum. 1968; 11 :106–114. [ PubMed ] [ Google Scholar ]
18. Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Phillips RK. Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg. 1996; 183 :257–261. [ PubMed ] [ Google Scholar ]
Articles from World Journal of Gastroenterology are provided here courtesy of Baishideng Publishing Group Inc
1. Nichols DH, Genadry RR. Pelvic relaxation of the posterior compartment. Curr Opin Obstet Gynecol. 1993; 5 :458–464. [ PubMed ] [ Google Scholar ] [ Ref list ]
2. Pucciani F, Rottoli ML, Bologna A, Buri M, Cianchi F, Pagliai P, Cortesini C. Anterior rectocele and anorectal dysfunction. Int J Colorectal Dis. 1996; 11 :1–9. [ PubMed ] [ Google Scholar ] [ Ref list ]
3. D'Avolio M, Ferrara A, Chimenti C. Transanal rectocele repair using EndoGIA: short-term results of a prospective study. Tech Coloproctol. 2005; 9 :108–114. [ PubMed ] [ Google Scholar ] [ Ref list ]
5. Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M. Rectocele: pathogenesis and surgical management. Int J Colorectal Dis. 2003; 18 :369–384. [ PubMed ] [ Google Scholar ] [ Ref list ]
6. Heriot AG, Skull A, Kumar D. Functional and physiological outcome following transanal repair of rectocele. Br J Surg. 2004; 91 :1340–1344. [ PubMed ] [ Google Scholar ] [ Ref list ]
7. D'Hoore A, Vanbeckevoort D, Penninckx F. Clinical, physiological and radiological assessment of rectovaginal septum reinforcement with mesh for complex rectocele. Br J Surg. 2008; 95 :1264–1272. [ PubMed ] [ Google Scholar ] [ Ref list ]
8. Reisenauer C, Huebner M, Wallwiener D. The repair of rectovaginal fistulas using a bulbocavernosus muscle-fat flap. Arch Gynecol Obstet. 2009; 279 :919–922. [ PubMed ] [ Google Scholar ] [ Ref list ]
9. Tantanasis T, Giannoulis C, Daniilidis A, Papathanasiou K, Loufopoulos A, Tzafettas J. Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence? Hippokratia. 2008; 12 :108–112. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
10. Nichols DH, Milley PS. Identification of pubourethral ligaments and their role in transvaginal surgical correction of stress incontinence. Am J Obstet Gynecol. 1973; 115 :123–128. [ PubMed ] [ Google Scholar ] [ Ref list ]
11. Delancey JO, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008; 199 :610.e1–610.e5. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
12. DeLancey JO. Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol. 1999; 180 :815–823. [ PubMed ] [ Google Scholar ] [ Ref list ]
13. Porter WE, Steele A, Walsh P, Kohli N, Karram MM. The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol. 1999; 181 :1353–1358; discussion 1358-1359. [ PubMed ] [ Google Scholar ] [ Ref list ]
14. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut. 1989; 30 :1737–1749. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
15. Guarnieri A, Cesaretti M, Tirone A, Vuolo G, Verre L, Savelli V, Piccolomini A, Di Cosmo L, Carli AF, Burroni M, et al. [Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience] Chir Ital. 2008; 60 :243–248. [ PubMed ] [ Google Scholar ] [ Ref list ]
16. Yamana T, Takahashi T, Iwadare J. Clinical and physiologic outcomes after transvaginal rectocele repair. Dis Colon Rectum. 2006; 49 :661–667. [ PubMed ] [ Google Scholar ] [ Ref list ]
17. Sullivan ES, Leaverton GH, Hardwick CE. Transrectal perineal repair: an adjunct to improved function after anorectal surgery. Dis Colon Rectum. 1968; 11 :106–114. [ PubMed ] [ Google Scholar ] [ Ref list ]
18. Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Phillips RK. Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg. 1996; 183 :257–261. [ PubMed ] [ Google Scholar ] [ Ref list ]

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Correspondence to: Yun-Sheng Li, Professor, Department of Anatomy and Neurobiology, Tianjian Medical University, Qixiangtai Road 22, Heping District, Tianjin 300070, China. nc.ude.umjit@nijuil
AIM: To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography (CT) and reveal its were relationship to rectocele.
METHODS: A total of twenty female volunteers without rectocele were examined by CT scan. We performed a middle level continuous horizontal pelvic scan from the upper part to the lower part and collected the measurement data to analyze the results using t -test.
RESULTS: Twenty volunteers were enrolled in the study. The space between the posterior wall of the vagina and the anterior wall of the rectum was measured at three levels (upper 1/3, middle, lower 1/3 level of vagina). The results showed that the space from the posterior wall of the vagina to the anterior wall of the rectum at the upper 1/3 level and the middle level was 3.896 ± 0.3617 mm and 4.6575 ± 0.3052 mm, respectively. When the two groups of data were compared, we found the space at the upper 1/3 level was shorter than at the middle level ( P < 0.01). Moreover, at the lower 1/3 level the space measured was 10.058 ± 0.4534 mm. The results revealed that the space at the lower 1/3 level was longer than that at the middle level ( P < 0.01).
CONCLUSION: These measurement data may be helpful in assessing rectocele clinical diagnosis and functional outcomes of rectocele repair.
Rectocele (h
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