Anal sphincteroplasty is a procedure used to repair torn or weakened anal sphincter muscles, the muscles that control bowel movements.
Damage to these muscles is a major cause of fecal incontinence, the loss of normal bowel control.
There are two anal muscles that control bowel movements. These muscles are similar to two round doughnuts, one inside the other. Anal sphincteroplasty is used when there is a defect in this circle of muscle.
Also known as anal sphincter repair, the procedure is commonly used to treat fecal incontinence caused by anal muscles damaged during childbirth. The procedure is performed under general or regional anesthesia.
The transfer of the gracilis muscle for anal sphincteroplasty, which was initially described for neurogenic dysfunction, is recommended for repair and reconstruction of traumatic and dysfunction. The use of this technique in two patients with anal incontinence following trauma proved to be helpful in alleviating the problems of the patients. A diverting colostomy is used prior to the repair of the anal sphincter. Physical therapy regimens of the reconstructed anal sphincter by the muscle transfer is done prior to closing of the colonic stoma and restoring normal continuity and function of the lower part of the alimentary tract.
Who candidate Anal Sphincteroplasty?
- who have Leaking of stool.
Pre-OP for Anal Sphincteroplasty?
Before surgery, a pre-op appointment will be scheduled with your doctor at their office or with a nurse practitioner or physician assistant at Domino Farms.
- Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery.
- The lab work for your surgery must be done at least 3 days before surgery.
- Some medications need to be stopped before the surgery. A list of medications will be provided at your pre-operative appointment.
- Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery.
- Most women recover and are back to most activities in 6 weeks.
Anal Sphincteroplasty procedure
Anal sphincteroplasty involves an incision in between the rectum and vagina in order to gain access to the anal sphincter. Once the sphincter is identified, it subsequently dissected out and separated in order to allow for subsequent overlapping repair to restore the muscle all the way around the rectum.
Post-OP for Anal Sphincteroplasty
The patient can take showers the day after surgery but should avoid long stays in water during 2 weeks. The suture line is disinfected 2 to 3 times per day and of course after each bowel movement. The wound is protected with a simple pad of gauze hold in place by a slip.
We don’t restrict bowel movement any more. We order laxatives and paraffin oil from the day of surgery. As soon as the patient feels the need to pass stools, an enema should be given at any time, day and night, in order to have liquid stools passing without straining. Normal diet is continued; mucilage and bulk-forming agents are given together with paraffin oil for 2 to 3 weeks.
Physical training of the sphincter and biofeedback should not be encouraged before day 15 .Thereafter the patient should three times a day contract and pull up his sphincters in directionof the umbilicus 10 to 20 times. Duration of contraction should be shorter than duration of relaxation in order to avoid any ischemia of the muscles. The patient should go on with this form of self-training life long.
Side effect and recovery Anal Sphincteroplasty
Postoperative complications are rare but may be severe:
- infection in up 24% of cases
- skin dehiscence
- persistant incontinence.
- sphincter suture leak
Sphincteroplasty is successful in more than 90% of patients with faecal incontinence due to sphincter injury, restoring most of them almost completely to normal