Diseases

Anal incontinence: a surgical operation

To treat faecal incontinence, when the drugs are not sufficient and the reeducation is not effective, it is sometimes necessary to consider a surgical repair of the anal sphincter. If, for many years, the only surgical answer was the terminal colostomy, new techniques have been practiced for about ten years.

The artificial sphincter

It is a silicone device, semi-automatic and composed of three interconnected elements. First an inflatable cuff placed around the anus and whose mission is to ensure anal occlusion. Then a tank balloon and pressure regulator placed next to the bladder. Finally, a pump, placed in the big lip at the woman, or in the scrotum at the man: it is this part which is accessible to the patient.

The defecation is activated by some pressure of this little pump: the perianal cuff is empty of the water it contains allowing the opening of the anus (it fills automatically with water, again, some minutes later).

Warning: if the installation of an artificial anal sphincter is simple (a week of hospitalization, anyway), it is necessary to monitor well the infectious risks that may occur during the course of the intervention.

Neuromodulation

The anal pacemaker or neuromodulation: it is a question of placing an electrode at the level of the nerves which control the sphincter. The electrical pulses are delivered by an internal casing. This technique gives good results: nearly two in three patients are improved. As for risks or side effects: possible complications are infectious, but also risks of pain at the site of the implant or displacement of the electrode. Regular monitoring is therefore necessary.

Graciloplasty

This is a kind of auto-transplant. A muscle is used, the gracilis muscle (which is inside the thigh) will replace the deficient sphincter. The muscle bandage will wrap the anal canal. This is a fairly heavy intervention, reserved for those for whom all other treatments have failed.

Finally, when the sphincter is broken, it is possible to operate to repair the best that we can sphincter.

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To see also:

> Question digestion: stool color abnormal - is this serious?
> All about urinary incontinence

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