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Colon
The colon starts in the right lower quadrant as the cecum.
This then connects to ascending, transverse, descending and
sigmoid colon. The rectum and anus mark the termination of
the colon
Primary function of the ascending colon is to absorb
electrolytes and water, the primary function of the
descending colon is to store fecal material until evacuation
Secreting mucus, supporting growth of symbiotic bacteria
are other functions of colon
Normal colonic transit time is 12 to 30 hours
Fluids up to 30lts/day can be reabsorbed by bowel
Introduction
Haustrations and mass movements are two types of colonic
motility
Haustrations: circular muscular contractions of the colon that
cause mixing of colonic contents, generally they do not cause
any forward movement of the stool
Mass movements: are large areas of muscular contractions
that propel food forwards inside the colon(last 10 to 30 min)
Enteric nervous system
• Myenteric plexus (Auerbach’s) is located between the outer
longitudinal and the inner circular muscle layers, controls
motor activities such as tonic and rhythmic contractions
• Submucosal plexus ( Meissner’s) is located in the submucosa,
controls local intestinal secretion and absorption
• Enteric nervous is functionally independent but is partially
controlled by the autonomic nervous system
• Neurotransmitters include Ach, NA, dopamine,
cholecystokinin, somatostatin
Autonomic nervous system
In general parasympathetic nervous system(PS) increases
peristalsis, stimulates secretions, relaxes sphincters, and
increases gut motility
Vagus nerve supplies the PS innervation from esophagus to
mid-transverse colon. There is minimal PS innervation to
small intestine
Pelvic nerve originates in the lateral anterior gray columns of
spinal cord segments S2, S3, S4 and supplies the
parasympathetic innervation from mid-transverse colon to
the rectum
Autonomic nervous system
In general, the sympathetic nervous system decreases
peristalsis, inhibits secretions, contracts sphincters, and
decreases gut motility
The preganglionic fibers originate in the intermediolateral
column of the spinal cord between T5 and L2
The superior and inferior mesenteric(T9 to T12) and
hypogastric(T12 to L3) nerves contain postganglionic
sympathetic fibers
Unlike PS, sympathetic nervous system neurons are equally
distributed
Reflexes of gastrointestinal system
Gastro colic
Increase in colonic activity that occurs 30 to 60min after a meal
Distention of the stomach stimulates evacuation of the colon
Blunted, but still useful after SCI
Enterogastric
Distention and irritation of the small intestine results in suppression of
secretion and motor activity in the stomach
Colocolonic
Propels stool caudally by proximal muscle constriction and distal dilatation
Mediated by myenteric plexus
Recto colic
Colonic peristalsis due to stimulation(mechanical or chemical) of rectum
Mediated by pelvic nerve
Anorectal
Involuntary relaxation of internal sphincter as stool passes into rectum
Normal defecation
The internal anal sphincter is composed of involuntary smooth
muscle and provides continence in resting state by remaining
tonically contracted
The external sphincter, innervated by the pudendal nerve(S2 to
S4) is composed of striated muscle, provides voluntary
control of defecation and prevents incontinence along with
the puborectalis during cough or valsalva maneuver
Recto sigmoid distention stimulates recto rectal reflex
Bowel proximal to bolus contracts
Bowel distal to bolus relaxes
Normal defecation
• Reflex relaxation of internal anal sphincter( anorectal reflex)
Correlates with the “urge to go”
The external anal sphincter and puborectalis prevent
defecation( i.e., the holding reflex) if the conditions are not
appropriate, internal anal sphincter relaxation reflex will fade
(within approx 15 sec) and urge will resolve until triggered
again
Under voluntary control, the EAS and puborectalis relax
allowing defecation
Normal defecation
Neurogenic bowel
The neurogenic bowel is defined as the loss of direct somatic
sensory or motor control functions, with or without impaired
sympathetic and parasympathetic innervation