Fecal Incontinence Surgery | Sphincteroplasty Surgery - Montreal, QC

Sphincteroplasty Overview

What is fecal incontinence? It is the impaired ability to control the release of gas or stool at a desired time. The anal sphincter, in conjunction with the pelvic floor muscles, manage the release of gas and stool. When there is loss of control, whether partial or complete, it can disrupt one’s ability to participate confidently in everyday life, impacting quality of life and, often, personal relationships and social routines. 

Fecal incontinence is twice as common in women as it is in men. Women who have had prior pregnancies are especially at risk (labor during childbirth can cause an anal sphincter injury). Moreover, people who are 65 and older are at greater risk of developing this condition. People who have had prior anorectal surgeries may be more prone to incontinence when procedures result in direct sphincter damage, postoperative scarring that alters anal canal function, or nerve injury that weakens sphincter control.

When is fecal incontinence surgery required?

Control of gas and bowel movements is key to maintaining one’s quality-of-life, everyday activities, and routines. It is enmeshed in society’s social norms and unwritten rules. Fecal incontinence can be deeply distressing and socially isolating, yet many people are unaware of its impact until they experience it. When an uncontrolled bowel movement occurs, it can be a major burden and source of embarrassment, especially if it happens in a public place. Unfortunately, many patients suffer in silence due to the stigma and embarrassment surrounding incontinence. It can even lead to a patient changing their lifestyle to avoid further embarrassment, and potentially negatively impact employment and personal relationships. It can also cause skin and anal irritations and infections, which can cause chronic irritation, and in rare cases, lead to secondary infections or complications, such as abscesses or fistulas that could require anal fistula surgery.

If you believe you suffer from fecal incontinence, consult your doctor to see what options are available to you. If you have exhausted other options for treating fecal incontinence, such as lifestyle changes, medications, pelvic floor exercises, sacral nerve stimulation, or others, surgical intervention may be required. There are different approaches to sphincteroplasty; overlapping anal sphincter repair strengthens the anal sphincter by overlapping and suturing torn muscle ends, while anterior anal sphincter repair specifically targets injuries in the front section of the sphincter. 

All surgeries, whether they be big or small, carry risks. For fecal incontinence surgery, these risks typically include:

What to expect prior to your fecal incontinence surgery

Antibiotics are routinely given to reduce infection risk; type and dosage will vary according to the patient’s medical profile. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems. Consult our surgery guidelines for more information about what to expect before and after your surgery. 

Sphincteroplasty is typically performed as an outpatient procedure. Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. General anesthesia will then be administered under the supervision of an anesthesiologist and your surgeon.

The procedure itself usually takes less than an hour to perform, depending on the complexity of the condition. Typically, your doctor will provide you with an estimate of how long your procedure is expected to take.

The sphincteroplasty procedure

Anal sphincteroplasty, or a direct repair of the injured anal sphincter muscles, is a well-established surgical procedure for patients with incontinence. It is most effective in patients with clearly defined sphincter defects, typically from obstetric injury or trauma. Direct repair can improve the effective functioning of the anal muscles. It involves an incision between the rectum and genitals in order to gain access to the internal anal sphincter. Once the injured portion of the sphincter is identified, it is subsequently dissected and separated in order to allow for overlapping repair to restore the muscle all the way around the rectum.

Once the procedure is completed, the incision is sutured and the patient is awoken and taken to a recovery room.

After the procedure

Recovery time for a sphincteroplasty will vary, but you should feel back to normal within a few weeks. Residual pain may last up to a week after surgery. Follow your discharge instructions carefully to prevent infection and ensure proper healing. Our team will provide you with detailed wound care guidance. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. In some cases, your care team may recommend alternating acetaminophen (Tylenol) with an anti-inflammatory like ibuprofen (Advil, Motrin) for pain control. Always follow your individualized post-op plan.