Anal Sphincter Repair
WHAT IS AN ANAL SPHINCTER REPAIR?
This is an operation in which the torn or damaged muscle around the anal canal is repaired with an operation.
WHEN IS A SPHINCTER REPAIR PERFORMED?
The anal sphincter is the ring of muscle around the lowest part of the bowel (the anus). It is responsible for enabling you to control opening your bowels. Damage to this muscle can cause you to lose full control over when you empty your bowel.
The most common cause of anal sphincter injury is a previous difficult childbirth. This may have been many years previously and sometimes patients become symptomatic only when the muscle weakens further with ageing and the menopause. If you have incontinence and you have evidence of a damaged external sphincter muscle but no signs of other problems (such as prolapse) then sphincter repair may be suitable for you.
WHAT OTHER TESTS ARE NECESSARY BEFORE THE OPERATION?
We will need to see you in clinic to assess your symptoms and to perform an examination.
Most patients having this operation will need an endoscopic (telescope) test on the bowel. We will also perform studies on the anal sphincter to look at its structure and function (anorectal physiology and ultrasound) and transit studies and a proctogram. These tests will look for damage to the sphincter muscle whilst ruling out other causes for your symptoms such as prolapse or inflammation.
If these other causes are found, then treatment of these would be recommended before considering sphincter repair.
WHAT DOES THE OPERATION INVOLVE?
The operation is performed under general anaesthetic. A cut is made in the skin of the perineum (between the anus and vagina in a woman).
The surgeon identifies the sphincter muscle and the area of damage. Healthy muscle is dissected free and overlapped to restore the ring of muscle around the anal canal. The operation takes 1-1.5 hours.
HOW DO I PREPARE FOR THE SURGERY?
The hospital will contact you before your operation to arrange for you to come in for a pre-assessment visit. This normally lasts 30-60 minutes.
At your visit you will have some basic health checks to ensure you are fit for surgery. These may include:
- Blood Pressure
- Urine Analysis
- Electrocardiogram (ECG)
- Medical History Questionaire
- MRSA Screen
The nurse will advise whether you should continue to take any regular medication.
You will also be given instructions about when to stop eating and drinking before your operation, what to bring into hospital with you and when to arrive.
WHAT IS THE RECOVERY LIKE AFTER THE SURGERY?
You will usually be in hospital for one to two nights after surgery.
You will be discharged on a weaning course of laxatives (usually Movicol) and you should take these for six weeks. It is important you do not get constipated as this may damage the repair.
Sometimes your surgeon will recommend that you take a course of antibiotics.
You can shower and bathe after the operation and this is helpful in keeping the area as clean as possible. You may be fit to drive after 1-2 weeks, return to work after 2-4 weeks but should not do any lifting for at least 6 weeks.
WHAT ARE THE RESULTS LIKE?
For carefully selected patients, about 60% will find that their bowel control and ability to hold on to stool will improve. Around 30% will find that their symptoms are unchanged whilst 10% may experience deterioration in symptoms. Any problems with control of wind are often not improved with surgery.
WHAT ARE THE RISKS?
Wound infection is very common with this operation because of the location of the wound. Minor wound infections settle with antibiotics and benefit from regular baths. Very occasionally, if patients get a serious wound infection, a temporary colostomy may be needed for a few weeks to help with healing.
Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment