Overlapping Sphincteroplasty

An overlapping sphincteroplasty is an operation performed to restore normal anal sphincter anatomy following an injury, or disruption, to the anal sphincter muscle that has led to the development of fecal incontinence. Oftentimes, this injury is the result of trauma from a vaginal delivery.  When the sphincter is disrupted, the muscle may not be able to squeeze and tighten effectively to prevent passage of stool, leading to fecal incontinence. The surgeon will reconnect the free ends of damaged muscle to reestablish the sphincter as a ring, leading to improved function. Sphincteroplasty has been used for decades in the treatment of fecal incontinence and is a very safe operation.

Preparation before surgery:
-Smoking cessation is an important way to optimize healing.

-A bowel preparation, similar to what is done prior to a colonoscopy, will be need to be completed the day before surgery.

-The operation is performed on an inpatient basis, with an expected hospital stay of about three days.

Aftercare:
-Patients can expect to have a wound to care for after the operation. The doctor will provide specific care instructions.

-It is normal to have pain after surgery. Patients may experience more pain with bowel movements.  The doctor will prescribe pain medication to take after surgery.

-It is important to avoid constipation initially following an overlapping sphincteroplasty. Eating a soft diet and taking a gentle laxative, such as Miralax can help avoid this.

Overlapping sphincteroplasty has been shown to be initially successful in up to 75% of patients with severe fecal incontinence and is necessary in cases where normal anatomy has been severely disturbed. However, there have also been discouraging reports about deterioration in function over time. In two studies, about half of the patients who underwent this treatment said they were experiencing some urinary or fecal incontinence, had required further surgery, or had developed other bowel problems, when contacted four to 12 years later.  Fortunately, we now have additional therapeutic interventions available to improve function if this occurs.