Anal sphincter

The external anal sphincter (or sphincter ani externus ) is a flat plane of muscular fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus.

The internal anal sphincter, IAS, (or sphincter ani internus) is a muscular ring that surrounds about 2.5–4.0 cm of the anal canal; its inferior border is in contact with, but quite separate from, the external anal sphincter.

It is about 5 mm thick, and is formed by an aggregation of the involuntary circular fibers of the rectum. Its lower border is about 6 mm from the orifice of the anus.

If a patient has the ability to contract the anal sphincter voluntarily or to feel a pinprick or touch around the anus, the injury is considered a incomplete spinal cord injury.

The nerves in this area are connected to the very lowest region of the spine, the sacral region, and retaining sensation and function in these parts of the body indicates that the spinal cord is only partially damaged. This includes a phenomenon known as sacral sparing.

The filum is differentiated from nerve roots by presence of characteristic squiggly vessel on surface of filum. Also, under the microscope, the filum has a distinctively whiter appearance than the nerve roots, and ligamentous-like strands can be seen running through it. NB: intra-op Electrostimulation and recording of anal sphincter EMG are more definitive.