Preliminary experience in management of fecal incontinence caused by internal anal sphincter injury

Abstract

PURPOSE: Isolated injuries of the internal anal sphincter can cause fecal incontinence. With the advent of ultrasound, which accurately delineates the anatomy of the anal sphincters, internal sphincter injuries can be diagnosed more precisely. The purpose of this study was to evaluate the outcome of direct repair of isolated internal anal sphincter defects. METHODS: Eight patients (6 males; median age, 37 years) with clinically and sonographically proved internal anal sphincter defects were the subject of this study. Patients had different degrees of incontinence that failed to respond to medical treatment. All patients had their sphincters repaired by direct apposition using coated Vicryl® 2-0 stitches. A strict postoperative regime that avoided stretch of the sphincter for one month was adopted. RESULTS: At a median follow-up period of 15 months, continence improved in all patients, and two achieved full continence. None of the patients wore pads. Mean continence score improved significantly from 4 to 12 and 11 at 6 and 12 postoperative months, respectively (P<0.0001, pairedt-test). CONCLUSION: Despite the limited number of patients and the short follow-up, the preliminary results of repair of isolated internal sphincter defects are satisfactory.