Types of Surgeries

Sphincteroplasty - Fecal Incontinence Surgery

Overview

What is fecal incontinence? It is the impaired ability to control the release of gas or stool at a desired time. A typical sufferer will have lost control of their anal sphincter, the muscle that constricts or relaxes the opening of the anus.

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 injure the anal sphincter). Moreover, people who are 65 and older are at greater risk of contracting this condition. People who have also had prior anorectal surgeries are more prone to incontinency.

Why?

Control of gas and stool is key to maintaining one’s quality-of-life, everyday activities, and routines. It is enmeshed in society’s social norms and unwritten rules. People often do not consider the negative impacts of such a condition until it happens to them. When it does occur, it can be a major burden and source of embarrassment, especially when accidents happen in public places. 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.

If you believe you suffer from fecal incontinence, consult your doctor to see what options are available to you. If you have exhausted all other options, surgical intervention may be required.

All surgeries, whether they be big or small, carry risks. For fecal incontinence surgery – in this instance, a sphincteroplasty – these typically include:

Risks

Risks of Surgery

  • Common complications include nausea, vomiting, urinary retention, sore throat, and headaches.
  • More severe complications include heart attack, stroke, pneumonia, and blood clots.
  • Infection of the surgical site.
  • Excessive bleeding from the anal area.
  • Pooling of the blood in the surgical site (hematoma).
  • Pain, swelling, itchiness or tenderness at the site of incision.
  • Fever.
  • Headaches and drowsiness after the surgery.
  • Recurrence of incontinence (long-term).
  • Occurrence of fistulas after surgery (long-term).
  • Narrowing (stenosis) of the anal canal.
  • Possibility of a rectal prolapse.

What to expect prior to your surgery

You may need to take antibiotics before surgery. 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.

A sphincteroplasty is a minor kind of surgery, and is done on an outpatient basis (you will be able to go home after the surgery is completed). 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 give you a heads up on how long the procedure should last.

The procedure

Anal sphincteroplasty, or a direct repair of the injured anal sphincter muscles, is a well-established surgical procedure for patients with incontinence. 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 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. Be sure to keep the area clean and dry to avoid the possibility of infection. 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. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.

 

Did you know we have a support group?

Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.