More effort is required because of concomitant anismus, or non-relaxation / paradoxical contraction of puborectalis ( which should normally relax during defecation ).
12.
After this, the location of the puborectalis muscle sling is assessed, and a perpendicular line between the pubococcygeal line and muscle sling is drawn.
13.
The relevant anatomy includes : the rectum, the anal canal and the muscles of the pelvic floor, especially puborectalis and the external anal sphincter.
14.
Others claim that puborectalis can become fibrosis ( replacement of muscle tissue with a more fibrous tissue ), which reduces voluntary control over the muscle.
15.
Injections of botulin toxin type-A into the puborectalis muscle are very effective in the short term, and somewhat effective in the long term.
16.
The internal and external anal sphincters along with the puborectalis muscle allow the feces to be passed by muscles pulling the anus up over the exiting feces.
17.
Conversely, relaxation of the puborectalis reduces the pull on the junction of the rectum and the anal canal, causing the anorectal angle to straighten out.
18.
It is now known that the components of levator ani ( the pelvic diaphragm ), namely pubococcygeus, puborectalis and ileococcygeus, contract and relax as one muscle.
19.
It terminates at the level of the anorectal ring ( the level of the puborectalis sling ) or the dentate line, again depending upon which definition is used.
20.
The increased pressure forces the anterior rectal lining against the contracted puborectalis and frequently the lining prolapses into the anal canal during straining and then returns to its normal position afterwards.
