Anal Incontinence Treatment

Anal or faecal incontinence can be a very debilitating disease.

There are many causes of faecal incontinence, but most common are with disorders of the anal sphincter and pelvic floor. Injuiries may occur following vaginal delivery, or other anorectal trauma. Other causes include radiation to the pelvis, inflammatory bowel disease, behavioural and neurological abnormalities.

Treatment depends on the cause, and hence multiple investigations are carried out.

Management often involves many different approaches. Some of these are outlined here.

• Biofeedback with physiotherapy,   dietary changes, and  medication
• Surgical correction of rectal prolapse or  haemorroids, sphincter repair.
• Sacral Nerve Neuromodulation (SNS)
• Other options include stoma formation, graciloplasty, sphincter  augmentation,  artificial sphincters, anal plug

Sphincter Repair

This procedure is carried out when the muscle of the anal canal, or sphincter has been torn. This injury most often occurs through vaginal delivery of childbirth. The tear may have been recognised at the time of delivery and repaired, or may not have been obvious, and thus not diagnosed.

A 3rd degree tear involves the injury to some or all of the muscle. A 4th degree tear involves a tear that also includes the lining of the anal canal wall.

There are occasions when a 3rd or 4th degree tear has been recognised and repaired soon after delivery, but it breaks down. In this scenario, a re-do of the repair is carried out, usually 3-6 months later, to allow all the scar and inflammatory tissue to settle.

Some people may be diagnosed with a “missed ” or “occult” sphincter injury in the first 6-12 months after their delivery , or later on in life when symptoms of faecal incontinence develop.

Repair of the sphincter requires a cut through the perineum, and dissection between the anus and vagina. The ends of the sphincter muscle are dissected then sutured together.

Sometimes a drain is left in the are for a few days to drain any excess fluid of blood. A catheter may be left in for 1-2 days for comfort. A pack may be left in the vagina and removed the flowing day.

You may be kept in hospital for a few days, with minimal activity. You will be able to eat and drink straight away, and often will be commenced of stool softeners. You will require analgesia, as this can be very uncomfortable.

It is important not to sit on too much, as this may increase the risk of wound breakdown. We generally suggest to shower and pat the wound dry, but not to soak in a bath. The wound is then dried with a hair drier and a dry pad placed between the buttocks to keep the wound dry.

The skin may ooze or the wound open up. This is not uncommon as this area is a difficult one to keep immobile. If the wound opens that does not mean the muscle repair has failed. Often the wound to heal over after a few weeks with simple dressings. If the wound has fully opened up early on sometimes it is repaired in theatre in an attempt to speed up the healing process.

Sacral Nerve Stimulation

Sacral Nerve Stimulation or SNS is a minimally imvasive treatment for faecal incontinence.

SNS uses mild electrical pulses to continuously stimulate the sacral nerves, providing the most distal autonomic and somatic nerve supply to the pelvic floor and gastrointestinal tract.

A test stimulation can be performed where a temporary electrode is inserted via a minimally invasive procedure, performed under local or general anaesthesia and stimulation is provided by an external pulse generator. The patient completes a bowel diary before the procedure and during a week long trial stimulation, only those patients with a satisfactory response are offered the permanent implant.

Biofeedback

Biofeedback is a type of physiotherapy that is used to help people who are having problems with controlling their anus and rectum (or back passage).

Biofeedback therapy is for people who suffer from faecal incontinence, chronic constipation or needing to retrain your bowel after surgery. The aim is to help strengthen the muscles around the anus and rectum to become stronger and hold onto bowel movements better, or to be able to open your bowels more effectively.

The biofeedback therapy programme we usually refer to is at the Bankstown Hospital SKC Wong Centre For Anorectal Diagnostics and Treatment and is run by an experienced nurse trained in biofeedback techniques and education.

This treatment is integral in the management of these common problems, as there are many factors that affect bowel function and continence, and many need simple changes that the biofeedback nurse will discuss with you.

The program usually consists of monthly sessions, held in the centre, or over the phone for up to 6 months. The fist appointment will always be a face-to-face session at the centre. The biofeedback nurse will determine the type of therapy techniques you require for your condition and how long you will need therapy based on the information you give on how you are progressing.

After the treatment has been completed you may need to follow up with your specialist to see if any further surgical intervention is required.

For more information on this treatment download here