Mahatmasara Adhiwasa (0906550865)

DEFECATION
Motility in the large intestine Chyme that enters the colon continues to be mixed by segmental contractions. A wave of contraction decreases the diameter of a segment of colon and sends a substantial bolus of material forward. These contractions occur 3-4 times a day and are associated with eating and distension of the stomach through the gastrocolic reflex. Mass movement is responsible for the sudden distension of the rectum that triggers defecation.1

Gastrocolic reflex When food enters the stomach, mass movements occur in the colon primarily by means of gastrocolic reflex. In many people, this reflex is most evident after the first meal of the day and is often followed by the urge to defecate. Thus when a new meal enters the digestive tract, reflexes are initiated to move the existing contents farther along down the tract to make way for the incoming food. The gastroileal reflex moves the remaining small intestine contents into the large intestine, and the gastrocolic reflex pushes the colonic contents into the rectum, triggering the defecation reflex.2

Defecation The rectum is usually empty, but when feces are forced into it by mass movements, stretching of the rectal wall initiates the defecation reflex. This is a spinal cord mediated parasympathetic reflex that causes the sigmoid colon and the rectum to contract, the internal anal sphincter to relax, and the external anal sphincter to contract (initially). As feces are forced into the anal canal, messages reach the brain allowing us to decide whether the external (voluntary) anal sphincter should be opened or remain constricted to stop feces passage temporarily. If defecation is delayed, the reflex contractions end within a few seconds, and the rectal walls relax. With the next mass movement, the defecation reflex is initiated againand so on, until one chooses to defecate or the urge to defecate becomes unavoidable. During defecation, the muscles of the rectum contract to expel the feces. We aid this process voluntarily by closing the glottis and contracting our diaphragm and abdominal wall muscles to increase the intra-abdominal pressure (a procedure called Valsalvas maneuver). We also contract the levator ani muscle , which lifts the anal canal superiorly. This lifting action leaves the feces below the anusand outside the body. Involuntary or automatic defecation (incontinence of feces) occurs in infants

because they have not yet gained control of their external anal sphincter. It also occurs in those with spinal cord transections.3 Defecation, like urination, is subject to emotional influence. Stress may increase intestinal motility and cause psychosomatic diarrhea in some individuals, but in other individuals it can decrease motility and cause constipation in others. When feces are retained in the colon, either through consciously ignoring a defecation reflex or through decreased motility, continued water absorption creates hard, dry feces that are difficult to expel. One treatment for constipation is glycerin suppositories, small bullet-shaped wads that are inserted through the anus into the rectum. Glycerin attracts water and helps soften the feces to promote defecation.1

Silverthorn DU. Human Physiology : An Integrated Approach. 3rd ed. Pearson Education; 2004. P.686-687.
2

Sherwood L. Human Physiology From Cells to Systems. 5th ed. Thomson Learning; 2004. P.638. Marieb EN, Hoehn K. human Anatomy & Physiology. 7th ed. Pearson Education; 2007