Anal canal

Last revised by Yoshi Yu on 5 Apr 2023

The anal canal is the terminal part of the gastrointestinal tract, whilst the anus (plural: anuses or ani) specifically refers to the opening separating the anal canal from the outside, at the distal most aspect of the anal verge. Anatomically, the anal canal is referred to as the terminal alimentary tract between the dentate line and anal verge. However, histologically it extends more proximally and includes the anal columns (of Morgagni) and anal sinuses. Surgically, the anal canal is referred to as the portion of bowel between the anorectal sling and the anal verge. 

The anal margin is arbitrarily defined as the 5 cm of skin (radius) surrounding the anal verge

The anal canal measures ~4 cm long and is continuous with the rectum at the anorectal junction, which is the angle (the anorectal angle) the rectum makes at the levator ani.

The anal canal is a muscular tube, like the rest of the gastrointestinal tract, with the muscular layer forming the external and internal anal sphincters

The anal canal contains longitudinal folds of mucosa, termed the anal columns which join inferiorly to form semicircular anal valves. The anal valves collectively form the dentate (pectinate) line, which marks the embryological anal membrane and divides the anal canal into an upper and lower parts, differing in structure and neurovascular supply.

The dentate line is a "watershed area" and the exact transition of epithelium and neurovascular supply is variable.

Above the dentate line, the epithelium is mucous membrane (columnar epithelium) like the rest of the gastrointestinal tract. Inferior to the dentate line is a transition zone, lined by nonkeratinised stratified squamous epithelium known as the anal pecten 3. Further inferiorly the anal pecten ends at the anocutaneous (white) line, where the epithelium becomes true skin (i.e. keratinized stratified squamous with hair and sebaceous glands) 3.

Venous drainage richly anastomoses with the rectal venous plexus

The anal canal is a site of portosystemic anastomosis

The upper part of the anal canal derives from the dorsal compartment of the cloaca (endoderm) and the lower part is derived from proctodeum (ectoderm).

  • imperforate anus

    • 1 in 1500-5000 newborns

    • failure of the anus to correctly form

    • may vary from stenosis to blind anal canal/rectum to absent anal canal

  • anal cancer

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