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The external anal sphincter or sphincter ani externus is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus. In a considerable proportion of cases the fibers decussate in front of the anus, and are continuous with the superficial transverse perineal muscle. Posteriorly, they are not attached to the coccyx, but are continuous with those of the opposite side behind the anal canal.

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In NovemberCross was diagnosed with anal cancer after a routine digital rectal examination by her gynecologist. The cancer was caught early, and she underwent 6 weeks of radiation and chemotherapy. Throughout the treatment, which Cross described as "gnarly," she tried to maintain her sense of humor.

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What are anal warts? Anal warts, also known as condyloma, are growths found on the skin around the anus rectal opening or in the lower rectum. What causes anal warts?

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Symptoms are variable, including anal pain, tenesmuspruritus, and sepsis. The most commonly accepted pathophysiology is the cryptoglandular hypothesis, which posits that obstruction of the deep submucosal glands results in infection and abscess formation in the intersphincteric space, which consequently drains inferiorly between the sphincters, opening onto the skin surface or, less commonly, erodes through both the internal and external sphincters into the ischiorectal spacethen onto the skin surface 4. Transsphincteric fistulae are secondary to ischiorectal abscesses, with a resultant extension of the tract through the external sphincter.

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Anal endosonography is a new technique that is useful in the preoperative assessment of patients with anal fistulas. Endosonographic images are created by the reflection of sound waves from the interfaces between tissues of varying densities. In order to accentuate tissue interface layers at the level of the fistula tract, we introduced hydrogen peroxide into the fistula tract through the external opening during anal ultrasonography in two patients with recurrent anal fistula.

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