Asshole Winking

Asshole Winking
If playback doesn't begin shortly, try restarting your device.
Videos you watch may be added to the TV's watch history and influence TV recommendations. To avoid this, cancel and sign in to YouTube on your computer.
An error occurred while retrieving sharing information. Please try again later.
0:02 / 5:22 • Watch full video Live

down arrow icon

left arrow icon

right arrow icon

left arrow icon

article info icon

article alerts icon

article stats icon

article text icon

shopping basket icon

checkbox unchecked

checkbox checked

citation tools icon

close icon

facebook icon

google plus icon

journals icon

menu icon

openaccess icon

plus icon

publish icon

related icon

responses icon

rss icon

search icon

share icon

sound cloud icon

star icon

twitter icon

youtube icon

BMJ logo

For personal accounts OR managers of institutional accounts

For personal accounts OR managers of institutional accounts

Home
Archive
Volume 48, Issue 5
A winking anus may signify spinal injury

A winking anus may signify spinal injury
Glickman S , Kamm MA ( 1996 ) Bowel dysfunction in spinal cord injury patients. Lancet 347 : 1651 – 1653 .
Chiotakakou-Faliakou E , Kamm MA , Roy AJ , et al. ( 1998 ) Biofeedback provides long term benefit for patients with intractable slow and normal transit constipation. Gut 42 : 517 – 521 .
Kamm MA , Lennard-Jones JE ( 1990 ) Rectal mucosal electrosensory testing. Evidence for a sensory neuropathy in severe constipation. Dis Colon Rectum 33 : 419 – 423 .
Speakman CTM , Hoyle CHV , Kamm MA , et al. ( 1990 ) The adrenergic control of the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence. Br J Surg 77 : 1342 – 1344 .
O M Jones
A F Brading
N J McC Mortensen

Gut 2002; 50 440-440 Published Online First: 01 Mar 2002. doi: 10.1136/gut.50.3.440

For personal accounts OR managers of institutional accounts

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Case report— A 41 year old woman was referred for assessment of worsening bladder and bowel dysfunction. At the age of 17 years she had suffered a traumatic fracture-subluxation of T12–L1 following a trampoline accident in which she fell heavily on to her back. She immediately lost sensation below the waist but this returned over several days. Following eight weeks of bed rest she gradually regained the ability to walk. She subsequently had no neurological deficit in her legs.
Since the accident she had experienced bladder and bowel dysfunction. She experienced urinary frequency, urgency, urge incontinence, and episodes of spontaneous bladder emptying without warning. There had been no stress incontinence. Urodynamic studies showed a small capacity bladder of 257 ml but good voiding and minimal residual volume (30 ml). She did however have marked urgency at 150 ml.
From a gastrointestinal point of view, she developed constipation following her injury. During her twenties she passed several small firm stools daily. During her thirties she developed episodes of abdominal pain, occurring approximately every two months, followed by diarrhoeal episodes over several hours. Continence was not impaired. Colonoscopy was normal.
On rectal examination the anus was closed at rest and of reasonable tone initially but gaped after digital examination (figs 1 , 2 ) for several minutes, with eventual return to normal resting tone. Palpable voluntary anal sphincter contraction was absent. Perianal skin sensation to light touch and pinprick was reduced.
Gaping anus two minutes after digital examination.
Anorectal physiological testing showed a low maximum resting anal pressure (45 cm H 2 O, normal >60), indicating internal anal sphincter dysfunction, and a low maximum anal squeeze pressure (8 cm H 2 O, normal >60), indicating external sphincter dysfunction. The sensory threshold to an electrical stimulus was grossly abnormal in both the rectum (61 mA, normal <35) and the anal canal (88 mA, normal <12).
Management consisted of simple symptomatic measures, including analgesics and antidiarrhoeal medications as required.

Discussion— Bowel dysfunction is common in the general population but is especially common after spinal injury. A study of 115 chronically spinally injured patients showed that 95% experienced constipation, faecal incontinence, or both. 1 Fifty per cent of patients relied on the help of another person for bowel evacuation. Patients rated their bowel disability almost as troublesome as their loss of physical mobility, and worse than their urinary symptoms. Although these data refer to patients with permanent para- or quadriplegia, bowel dysfunction can also persist after partial or transient spinal lesions.
As bowel dysfunction is also common in the general population, especially in young women, it is helpful to have a test that distinguishes idiopathic functional disturbance from that related to permanently impaired neurological innervation. This is important for clinical reasons, as the former may respond more easily to behavioural techniques such as biofeedback retraining. 2 It is also of medicolegal importance. The testing of rectal sensation to an electrical stimulus 3 often enables this distinction to be made, providing clear evidence in our patient of impaired innervation.
To our knowledge the sign of anal gaping after digital examination as a marker of neurological impairment has not been described previously. Normally the anal canal remains closed before, during, and after examination. The decrease in anal tone after digital examination in this patient may reflect loss of the normal extrinsic parasympathetic excitatory drive to the internal anal sphincter smooth muscle which maintains tone, and unopposed extrinsic sympathetic drive which relaxes the sphincter. 4 Given that this was a T12–L1 lesion, only part of the sympathetic outflow may have been lost. It is uncertain what proportion of parasympathetic and sympathetic autonomic innervation remained. Lack of modulation of sacral reflexes involving the sphincter and sacral spinal cord from cerebral centres may also contribute to this abnormality. The abnormal rectal sensation and bladder dysfunction provided supportive evidence that the “winking anus sign” is truly a reflection of impaired innervation. This patient was probably not incontinent because of her firm stools.
This sign should be distinguished from the “gaping anus” seen in some patients with faecal incontinence or rectal prolapse. In these patients anal tone is permanently diminished and the sphincter remains “open”.
Some patients develop worsening bowel symptoms many years after their spinal injury. This may relate to progressive enteric neurological changes secondary to chronic loss of extrinsic innervation, although evidence in support of this has not been sought.
Online: ISSN 1468-3288 Print: ISSN 0017-5749
Copyright © 2022 BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.

down arrow icon

left arrow icon

right arrow icon

left arrow icon

article info icon

article alerts icon

article stats icon

article text icon

shopping basket icon

checkbox unchecked

checkbox checked

citation tools icon

close icon

facebook icon

google plus icon

journals icon

menu icon

openaccess icon

plus icon

publish icon

related icon

responses icon

rss icon

search icon

share icon

sound cloud icon

star icon

twitter icon

youtube icon

BMJ logo

For personal accounts OR managers of institutional accounts

For personal accounts OR managers of institutional accounts

Home
Archive
Volume 48, Issue 5
A winking anus may signify spinal injury

A winking anus may signify spinal injury
Glickman S , Kamm MA ( 1996 ) Bowel dysfunction in spinal cord injury patients. Lancet 347 : 1651 – 1653 .
Chiotakakou-Faliakou E , Kamm MA , Roy AJ , et al. ( 1998 ) Biofeedback provides long term benefit for patients with intractable slow and normal transit constipation. Gut 42 : 517 – 521 .
Kamm MA , Lennard-Jones JE ( 1990 ) Rectal mucosal electrosensory testing. Evidence for a sensory neuropathy in severe constipation. Dis Colon Rectum 33 : 419 – 423 .
Speakman CTM , Hoyle CHV , Kamm MA , et al. ( 1990 ) The adrenergic control of the internal anal sphincter is abnormal in patients with idiopathic faecal incontinence. Br J Surg 77 : 1342 – 1344 .
O M Jones
A F Brading
N J McC Mortensen

Gut 2002; 50 440-440 Published Online First: 01 Mar 2002. doi: 10.1136/gut.50.3.440

For personal accounts OR managers of institutional accounts

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Case report— A 41 year old woman was referred for assessment of worsening bladder and bowel dysfunction. At the age of 17 years she had suffered a traumatic fracture-subluxation of T12–L1 following a trampoline accident in which she fell heavily on to her back. She immediately lost sensation below the waist but this returned over several days. Following eight weeks of bed rest she gradually regained the ability to walk. She subsequently had no neurological deficit in her legs.
Since the accident she had experienced bladder and bowel dysfunction. She experienced urinary frequency, urgency, urge incontinence, and episodes of spontaneous bladder emptying without warning. There had been no stress incontinence. Urodynamic studies showed a small capacity bladder of 257 ml but good voiding and minimal residual volume (30 ml). She did however have marked urgency at 150 ml.
From a gastrointestinal point of view, she developed constipation following her injury. During her twenties she passed several small firm stools daily. During her thirties she developed episodes of abdominal pain, occurring approximately every two months, followed by diarrhoeal episodes over several hours. Continence was not impaired. Colonoscopy was normal.
On rectal examination the anus was closed at rest and of reasonable tone initially but gaped after digital examination (figs 1 , 2 ) for several minutes, with eventual return to normal resting tone. Palpable voluntary anal sphincter contraction was absent. Perianal skin sensation to light touch and pinprick was reduced.
Gaping anus two minutes after digital examination.
Anorectal physiological testing showed a low maximum resting anal pressure (45 cm H 2 O, normal >60), indicating internal anal sphincter dysfunction, and a low maximum anal squeeze pressure (8 cm H 2 O, normal >60), indicating external sphincter dysfunction. The sensory threshold to an electrical stimulus was grossly abnormal in both the rectum (61 mA, normal <35) and the anal canal (88 mA, normal <12).
Management consisted of simple symptomatic measures, including analgesics and antidiarrhoeal medications as required.

Discussion— Bowel dysfunction is common in the general population but is especially common after spinal injury. A study of 115 chronically spinally injured patients showed that 95% experienced constipation, faecal incontinence, or both. 1 Fifty per cent of patients relied on the help of another person for bowel evacuation. Patients rated their bowel disability almost as troublesome as their loss of physical mobility, and worse than their urinary symptoms. Although these data refer to patients with permanent para- or quadriplegia, bowel dysfunction can also persist after partial or transient spinal lesions.
As bowel dysfunction is also common in the general population, especially in young women, it is helpful to have a test that distinguishes idiopathic functional disturbance from that related to permanently impaired neurological innervation. This is important for clinical reasons, as the former may respond more easily to behavioural techniques such as biofeedback retraining. 2 It is also of medicolegal importance. The testing of rectal sensation to an electrical stimulus 3 often enables this distinction to be made, providing clear evidence in our patient of impaired innervation.
To our knowledge the sign of anal gaping after digital examination as a marker of neurological impairment has not been described previously. Normally the anal canal remains closed before, during, and after examination. The decrease in anal tone after digital examination in this patient may reflect loss of the normal extrinsic parasympathetic excitatory drive to the internal anal sphincter smooth muscle which maintains tone, and unopposed extrinsic sympathetic drive which relaxes the sphincter. 4 Given that this was a T12–L1 lesion, only part of the sympathetic outflow may have been lost. It is uncertain what proportion of parasympathetic and sympathetic autonomic innervation remained. Lack of modulation of sacral reflexes involving the sphincter and sacral spinal cord from cerebral centres may also contribute to this abnormality. The abnormal rectal sensation and bladder dysfunction provided supportive evidence that the “winking anus sign” is truly a reflection of impaired innervation. This patient was probably not incontinent because of her firm stools.
This sign should be distinguished from the “gaping anus” seen in some patients with faecal incontinence or rectal prolapse. In these patients anal tone is permanently diminished and the sphincter remains “open”.
Some patients develop worsening bowel symptoms many years after their spinal injury. This may relate to progressive enteric neurological changes secondary to chronic loss of extrinsic innervation, although evidence in support of this has not been sought.
Online: ISSN 1468-3288 Print: ISSN 0017-5749
Copyright © 2022 BMJ Publishing Group Ltd & British Society of Gastroenterology. All rights reserved.

Could You Be the Next Men's Health 'Ultimate Guy'?
Tom Brady's New Running Collection Takes Off
Umbrella Academy Star's Transition Improved Life
Love Languages Don’t Matter as Much as You Think
Our Sex Columnist Answers 20 Personal Questions
My Wife Doesn’t Want to Orgasm. Is That Normal?
Zachary Zane
Zachary Zane is a Brooklyn-based writer, speaker, and activist whose work focuses on lifestyle, sexuality, and culture. He was formerly the digital associate editor at OUT Magazine and currently has a queer cannabis column, Puff Puff YASS, at Civilized.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

Advertisement - Continue Reading Below
The 15 Best Lubes for All Kinds of Sex
Temperature Play Is the Hottest Thing to Try
Advertisement - Continue Reading Below
The 25 Best Men's Health Sex Tips Ever
26 Foreplay Tips to Make Sex Even Better
17 Women on Why They Actually Love Giving Blowjobs
17 Ways to Touch a Vagina for Maximum Pleasure
12 Hot Sex Positions You Probably Haven't Tried
5 Harmless Reasons You Can't Get An Erection
12 Exercises That'll Make You Better at Sex
Master the Art of Erotic Massage in 6 Steps

Our product picks are editor-tested, expert-approved. We may earn a commission through links on our site.

"When you give in, it’s wet, tantalizing, tic
Melanie Moon Piss
Texas Patti Pics
Reyna De Courcy Nude

Asshole Winking

Report Page