Ritika (name changed) underwent surgery for a fistula of the anal area in 2020. She noticed that she was unable to hold stools and had to rush to the toilet. Many a times she had accidental leakage of stools without her knowing about it. The problem persisted for 6 months, while she was advised perianal exercises. She was becoming a social recluse and was finding it very difficult to concentrate at work. She looked up on google and thought that her control over passage of stools was compromised and it occasionally happens after fistula surgery. 

Most common causes of faecal incontinence

Ritika had actually developed faecal incontinence after surgery. This condition is also called anal or bowel incontinence too. There are lot of cause of this condition, the commonest being after prolonged labour during childbirth. It can also happen after trauma to perianal area or after perianal surgery for some other causes. There are plenty of other causes, but the above three mentioned are the most common.

Diagnosis of faecal Incontinence

She presented to us in July, 2020 and we found that she was suffering from moderate fecal incontinence along with fistula in ano. On clinical exam, we found that her anal sphincter was disrupted at the site of previous surgery. This circular anal sphincter is a muscular ring, which gives us our control over passage of stools depending upon circumstances. Since her muscle was partially cut, she was unable to contract the muscle completely, leading to incontinence. 

We got a MRI and anal manometry done and that confirmed our clinical diagnosis. We counselled Ritika about the need for surgery to repair the muscle as well surgery for fistula in ano. “It was a non brainer. My life had become hell and I was always afraid of moving out of the house or going to the market for shopping. My relationship with my husband had also suffered and thus there was an overall tension all around me”. 

Ritika was also apprised of need for staged surgery because of the fistula and also counselled about her wound and need for dressings in the post-operative period. She was also advised certain exercises to strengthen the torn muscle.

Also See: Fecal Incontinence Surgeon in Chandigarh

Surgery for faecal incontinence

The surgery Ritika required was anal sphincter repair along with seton surgery for fistula in ano. This surgery is called sphincteroplasty. The anal sphincter as described above is a very small ring shaped muscle. Its repair needs very careful dissection, freeing from the hard surrounding scar tissues and preserving the blood and nerve supply to the muscle. The muscle is then repaired with an overlap of edges and ring is restored. Subsequently, the anal opening has to be sculptured. 

Surgery has the best results, though at time redo surgery has to be done. If there is a complete tear in the muscle, then a diversion colostomy is also required temporarily. This colostomy helps in diverting the faecal matter away from the operated area, thus facilitating rest and less infection to the repaired wounds.

Recovery after surgery for faecal incontinences

Ritika had a partial tear and thus we could do the surgery without faecal diversion. The procedure took almost two hours and Ritika was discharged in two days. She did very well for both her surgeries and did not require any further surgery. In almost three weeks, once her wounds had healed and sutures out, Ritika could already feel the difference. She was fully continent in almost three months’ time. 

“Life has a different meaning now. I can move out of the house and can travel freely. I am also thinking of having a baby and waiting to get a yes from my surgeon.” Ritika says when she visited us early this year. She is doing fine and has full control over passage of her stools. 

Summary

• Up to 5% of the population suffers from this malady in some for
• There is reluctance to take opinion because of shyness, shame or anxiety.
• Faecal incontinence can be managed surgically.
• Situations, where the sphincter can be repaired gives the best results.
• The improvement in the continence can range from 30 to 90%.
• One should consult a colorectal surgeon for this surgery.