The anal canal consists of two separate and distinct muscles (Figure 82-1). The internal anal sphincter is a continuation of the circular smooth muscle of the rectum. The outer external sphincter is a continuation of the puborectalis muscle. Overlying the internal sphincter is the mucosa and the sub-mucosa of the anal canal. The dentate or pectinate line separates the transitional and columnar epithelium of the

FIGURE 82-1. Anal anatomy. Anatomic relationships in the perianal region.

rectum. It is at this level that the anal crypts and glands may become infected, leading to perianal fistulas.

The appearance of active CD is classic. In active perianal disease, the lesions are swollen and take on a translucent pink or bluish hue. As inflammation resolves, the tissues become opaque and the ulcers heal with a fragile layer of epithelium. Chronically, the tissues become thickened, fibrotic, and scarred. When CD is in an active state, wound healing is significantly prolonged, but may be relatively normal when the disease is quiescent.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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