1. Explain the mechanism of defecation!

I. PHYSIOLOGY

The rectum is usually empty before the defecation process. A person who has regular habits will feel
the need to defecate approximately at the same time every day. This is caused by a gastro-colic reflex
which usually works after breakfast. After, this food reaches the stomach and after digestion begins,
peristalsis in the intestines are stimulated, colonies, and leftovers from yesterday, which at night reach
the caecum begin to move. The contents of the pelvic colon enter the rectum, simultaneously hard
peristalsis occurs in the colon and feelings occur in the perineum. Intraabdominal pressure increases
with glottic closure and contraction of the diaphragm and abdominal muscle, the anal sphincter loosens
and the work ends (Pearce, 2002).

II. MECHANISM

The process of defecation occurs either consciously (volinter), or unconsciously (involuntary) or

reflexes. Movement that pushes feces towards the anus is hampered by a tonic contraction of the
internal anal sphincter consisting of smooth muscle and external anal sphincter consisting of skeletal
muscles. Sphincter external ani is regulated by N. Pudendus which is part of the somatic nerve, so
external ani is under the influence of our consciousness (volunteers).
 The defecation process begins with a defecation process due to the ends of the rectum nerve fibers
being stimulated when the rectum wall is stretched by fecal mass. This rectum compensation plays an
important role in the continence mechanism and also the rectal filling sensation is an important integral
part of normal defecation. This can be described as follows : When sigmoid colon volume becomes
large, nerve fibers will trigger contractions by emptying their contents into the rectum. This statistical
study of the physiology of the rectum describes three types of rectal contractions, namely:

(1) Simple contractions that occur in as many as 5-10 cycles / minute;

(2) Slower contractions of 3 cycles / minute with amplitudes above 100 cmH2O, and

(3) Slow Propagated Contractions with high frequency amplitude.

Distension of the rectum stimulates stretch receptors on the rectum wall, pelvic floor and anal canal.
When the faeces enters the rectum, rectal wall distension is sent afferent signals that spread through
the myenteric plexus which stimulates peristalsis in the descending colon, sigmoid colon and rectum so
that the faecal distension is sent into the afferent signal which spreads through the myenteric plexus
which stimulates the peristalsis in the descending colon, sigmoid colon and rectum so that the faecal
distension is pushed into the anus. After the peristalsis reaches the anus, the external anal sphincter is
relaxed by a signal that blocks the myenteric plexus, and the external anal sphincter at that time
experiences voluntary relaxation, defecation occurs.

At the beginning of the defecation, there is an increase in intraabdominal pressure by contraction of

the quadratus lumborum muscles, the rectus abdominis muscle, the internal and external obliquus
muscles, the transverse muscular abdominis and the diaphragm. the anorectal area makes a 90 degree
angle between the ampulla rekti and the anal canal so that it will be closed. So, when straight, this angle
will increase by around 130-140 degrees so that the analyst canal will be straight and the stool will be
evacuated. The external anal sphincterus will then constrict and extends analyst analysis.

Defecation can be inhibited by the contraction of the external anal sphincter under the influence of
consciousness (volunteer). If the defecation is held, the internal anal sphincter will be closed, the rectum
will hold relaxation to accommodate the faeces contained therein. The voluntary mechanism of the
defecation process appears to be governed by the arrangement of the central nervous system.
Afterwards, the stool evacuation process finishes closing the Reflexes. The internal anal sphincter mucus
and the puborectalis muscle will contract and the anorectal angle will return to its previous position.
This allows the internal anal sphincter muscle to restore the muscle tone and close the anal canal.
externus and m.levator ani contract to resist defecation.
 Reflexes in the Defecation Process

1. Intrinsic defecation reflex

Starting from the feces that enter the rectum so that rectal distension occurs, which then causes
stimulation in mesenteric flesus and peristaltic movements occur. Stools arrive dianus, systematically
spinghter internal relaxation then there is defecation

2. Parasympathetic defecation reflex

Stool that enters the rectum will stimulate the rectal nerve which is then passed on to the spinal cord.
From the spinal cord then returned to the descending colon, sigmoid and rectum which causes
peristalsis intensive, internal spinter relaxation, then defecation occurs.

Stool drive is also influenced by:

• Abdominal muscle contractions

• Diaphragm pressure

• Elevator muscle contraction

Source:

Ganong W. F. 19..Book on Teaching Physiology and MedicineEdition 17. Jakarta: EGC

Guyton A. C, Hall J. E. 2008. Fis Textbook