Güncel Proktoloji: Anorektal Hastalıklar ve Modern Yaklaşımlar

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DEFEKASYON VE KONTİNENS FİZYOLOJİSİ

Dr. Leyla Semiha ŞEN1
Doç. Dr. Gökhan YILMAZ2

1Marmara Üniversitesi, Pendik EAH, Genel Cerrahi Kliniği, İstanbul, Türkiye
2İstanbul Medipol Üniversitesi Tıp Fakültesi, Genel Cerrahi AD, İstanbul, Türkiye

ÖZET

Pelvis, sindirim, üreme ve üriner sistemlerin karmaşık şekilde bağlı olduğu bir anatomik bölgedir. Anorektal cerrahi hastalıkların etkin yönetimi için pelvisin anatomisi ve fizyolojisinin detaylı anlaşılması gereklidir. Konti- nans, Latince tenere (“tutmak”) kelimesinden türeyen ve dışkı kontrolünü ifade eden bir terimdir. Gastrointestinal sistemin kaudal ucu olan anorektum, dışkı kontinansının sağlanması ve dışkılamanın kolaylaştırılmasında önemli bir rol oynar. Pelvik taban, idrar ve dışkının depolanması ve boşaltılmasını kontrol eden kaslardan oluşan kubbe şeklinde bir yapıdır. Levator ani, koksigeus ve puborektalis kasları pelvik diyaframın ana bileşenleridir. Pelvik taban kasları, Tip I kas lifleri sayesinde yavaş kasılma ve yorgunluğa direnç özelliklerine sahiptir. Rektum, rektosigmoid bileşke ile anal açıklık arasında yer alır. Kas yapısı sayesinde dışkının depolanmasını ve dışkılama sırasında boşaltılmasını sağlar. Üst rektum arka bağırsaktan, alt rektum ise kloakadan köken alır ve bağ dokusu ile çevrilidir.

Anahtar Kelimeler: Fekal inkontinans; Pelvik taban; konstipasyon; Anal kanal; Pelvis

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