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Incontinence After Lateral Internal Sphincterotomy/Fistulotomy

  • Heather Rossi
  • David RothenbergerEmail author
Chapter

Abstract

Incontinence is defined as the involuntary loss of fecal material and/or gas through the anal canal and may range widely in severity. Normal continence is maintained by a complex interaction of the anal sphincter muscles and pelvic floor innervation. Sphincterotomy and/or fistulotomy may result in unintended disruption of the anal sphincter complex with subsequent incontinence. Lateral internal sphincterotomy (LIS) and fistulotomy are very effective treatments for chronic anal fissure (CAF) and fistula, respectively, with various techniques described for both. Varying degrees of success and rates of incontinence have also been reported for both procedures. Preoperative studies including anal manometry, endoanal ultrasonography, and/or MRI should be considered in individuals at increased risk of incontinence. Should continence issues develop postoperatively, significant symptomatic improvement may be achieved with conservative methods such as fiber and/or antidiarrheal agents. Biofeedback may be used if conservative management fails. For those individuals in whom conservative management fails, other options including injectables or implants may be appropriate to manage the incontinence.

Keywords

Fecal incontinence Lateral internal sphincterotomy Fistulotomy Anal fissure Treatment of chronic anal fissure Anal fistula Treatment of perianal fistula 

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryUniversity of Minnesota Medical SchoolSaint PaulUSA
  2. 2.Department of SurgeryUniversity of Minnesota Medical SchoolMinneapolisUSA

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