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Anus pp 133–155Cite as

Surgical Treatments for Incontinence

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Abstract

Fecal incontinence results from an impaired ability to control gas or stool to allow evacuation at a socially acceptable time and place. Normal continence depends on the consistency of the stool, capacity of the rectum, anorectal sampling reflex, and normal resting anal tone. It is maintained by the integrated action of the anal sphincters, the pelvic floor muscles, and intact neural pathways. Incontinence may result whenever any of these mechanisms malfunctions without adequate compensation. Treatment for fecal incontinence can be either medical or surgical. The aim of medical therapy is to alter stool consistency through dietary changes and antidiarrhoeal medications, with a concurrent or subsequent course of biofeedback. The multiple surgical alternatives range from minimally invasive procedures, such as injection of bulking agents and sacral nerve stimulation, to complete replacement of the sphincter mechanism with an artificial bowel sphincter or stimulated graciloplasty. However, despite the plethora of exciting advances, a stoma may be the most suitable option for certain patients.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC, Canada

    Marylise Boutros MD, FRCSC

  2. Division of Colorectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Marc C. Osborne MD

  3. Digestive Disease Center Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Steven D. Wexner MD, PhD (Hon), FACS, FRCS, FRCS(Ed)

  4. Academic Affairs, Florida Atlantic University College of Medicine, Boca Raton, FL, USA

    Steven D. Wexner MD, PhD (Hon), FACS, FRCS, FRCS(Ed)

  5. Clinical Education, Florida International University College of Medicine, Miami, FL, USA

    Steven D. Wexner MD, PhD (Hon), FACS, FRCS, FRCS(Ed)

Authors
  1. Marylise Boutros MD, FRCSC
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  2. Marc C. Osborne MD
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  3. Steven D. Wexner MD, PhD (Hon), FACS, FRCS, FRCS(Ed)
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Corresponding author

Correspondence to Steven D. Wexner MD, PhD (Hon), FACS, FRCS, FRCS(Ed) .

Editor information

Editors and Affiliations

  1. Department of GI Surgery, University College London Hospitals, London, United Kingdom

    Richard Cohen

  2. Department of GI Surgery, University College London Hospitals, London, United Kingdom

    Alastair Windsor

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Boutros, M., Osborne, M.C., Wexner, S.D. (2014). Surgical Treatments for Incontinence. In: Cohen, R., Windsor, A. (eds) Anus. Springer, London. https://doi.org/10.1007/978-1-84882-091-3_12

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