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Incontinence After a Lateral Internal Sphincterotomy: Are We Underestimating It?

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

PURPOSE

This study was designed to assess the long-term outcomes and quality of life of patients who have undergone a sphincterotomy for chronic anal fissure.

METHODS

The medical records of patients who underwent this operation between 1992 and 2001 were reviewed. A questionnaire was mailed to assess their current status, along with the Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index surveys.

RESULTS

A total of 298 patients were identified (158 males; 53 percent; mean age, 46.9 years; mean follow-up, 4.3 years). Postal survey response was 62 percent. Recurrence of the fissure occurred in 17 patients (5.6 percent) of whom 9 (52 percent) were females. Significant factors that resulted in recurrence were initial sphincterotomy performed in the office and local anesthesia (P < 0.001). When comparing office records and response to the postal survey, significantly more patients had flatal incontinence than that recorded in their medical records (P < 0.001). Twenty-nine percent of females who had a vaginal delivery recorded problems with incontinence to flatus (P = 0.04). Temporary incontinence was reported in 31 percent of patients and persistent incontinence to gas occurred in 30 percent. Stool incontinence was not a significant finding. The overall quality-of-life scores were in the normal range, whereas the median Fecal Incontinence Severity Index score was 12.

CONCLUSIONS

Recurrence after lateral internal sphincterotomy may be higher after local anesthesia or office procedure. Females who have two or more previous vaginal deliveries should be warned about possible flatal incontinence. Long-term flatal incontinence that is not reported to the caregiver may occur in up to one-third of patients and could be permanent.

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REFERENCES

  1. WR Schouten JW Briel JJ Auwerda EJ Graaf ParticleDe (1996) ArticleTitleIschaemic nature of anal fissure Br J Surg 83 63–5 Occurrence Handle1:STN:280:BymB28vgsFQ%3D Occurrence Handle8653368

    CAS  PubMed  Google Scholar 

  2. AP Zbar M Beer-Gabel AC Chiappa M Aslam (2001) ArticleTitleFecal incontinence after minor anorectal surgery Dis Colon Rectum 44 1610–9 Occurrence Handle1:STN:280:DC%2BD3Mnnt1yrsQ%3D%3D Occurrence Handle11711732

    CAS  PubMed  Google Scholar 

  3. TH Lewis ML Corman ED Prager WG Robertson (1988) ArticleTitleLong-term results of open and closed sphincterotomy for anal fissure Dis Colon Rectum 31 368–71 Occurrence Handle1:STN:280:BieB3M7jslI%3D Occurrence Handle3366036

    CAS  PubMed  Google Scholar 

  4. N Hananel PH Gordon (1997) ArticleTitleLateral internal sphincterotomy for fissure-in-ano-revisited Dis Colon Rectum 40 597–602 Occurrence Handle1:STN:280:ByiB1Mnnt1Y%3D Occurrence Handle9152191

    CAS  PubMed  Google Scholar 

  5. S Argov O Levandovsky (2000) ArticleTitleOpen lateral sphincterotomy is still the best treatment for chronic anal fissure Am J Surg 179 201–2 Occurrence Handle10.1016/S0002-9610(00)00307-X Occurrence Handle1:STN:280:DC%2BD3c3oslejsA%3D%3D Occurrence Handle10827320

    Article  CAS  PubMed  Google Scholar 

  6. RL Nelson (1999) ArticleTitleMeta-analysis of operative techniques for fissure-in-ano Dis Colon Rectum 42 1424–8 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVyjtA%3D%3D Occurrence Handle10566530

    CAS  PubMed  Google Scholar 

  7. J Garcia-Aguilar C Belmonte WD Wong AC Lowry RD Madoff (1996) ArticleTitleOpen vs. closed sphincterotomy for chronic anal fissure: long-term results Dis Colon Rectum 39 440–3 Occurrence Handle1:STN:280:ByiD3s3nsFI%3D Occurrence Handle8878506

    CAS  PubMed  Google Scholar 

  8. DC Nyam JH Pemberton (1999) ArticleTitleLong-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence Dis Colon Rectum 42 1306–10 Occurrence Handle1:STN:280:DyaK1Mvls1SgtQ%3D%3D Occurrence Handle10528769

    CAS  PubMed  Google Scholar 

  9. MR Keighley F Greca E Nevah M Hares J Alexander-Williams (1981) ArticleTitleTreatment of anal fissure by lateral subcutaneous sphincterotomy should be under general anesthesia Br J Surg 68 400–1 Occurrence Handle1:STN:280:Bi6B3cfpsVE%3D Occurrence Handle7016242

    CAS  PubMed  Google Scholar 

  10. AH Sultan MA Kamm RJ Nicholls CI Bartram (1994) ArticleTitleProspective study of the extent of internal anal sphincter division during lateral sphincterotomy Dis Colon Rectum 37 1031–3 Occurrence Handle1:STN:280:ByqD3cbitFw%3D Occurrence Handle7924711

    CAS  PubMed  Google Scholar 

  11. J Garcia-Aguilar C Belmonte Montes JJ Perez L Jensen RD Madoff WD Wong (1998) ArticleTitleIncontinence after lateral internal sphincterotomy: anatomic and functional evaluation Dis Colon Rectum 41 423–7 Occurrence Handle1:STN:280:DyaK1c3hvVGhtQ%3D%3D Occurrence Handle9559625

    CAS  PubMed  Google Scholar 

  12. AF Leong MJ Husain F Seow-Choen HS Goh (1994) ArticleTitlePerforming internal sphincterotomy with other anorectal procedures Dis Colon Rectum 37 1130–2 Occurrence Handle1:STN:280:ByqD2cvms1A%3D Occurrence Handle7956582

    CAS  PubMed  Google Scholar 

  13. JJ Tjandra WR Han BS Ooi A Nagesh M Thorne (2001) ArticleTitleFecal incontinence after lateral internal sphincterotomy is often associated with coexisting occult sphincter defects: a study using endoanal ultrasonography ANZ J Surg 71 598–602 Occurrence Handle10.1046/j.1445-2197.2001.02211.x Occurrence Handle1:STN:280:DC%2BD3MrgtlChtA%3D%3D Occurrence Handle11552935

    Article  CAS  PubMed  Google Scholar 

  14. TH Rockwood JM Church JW Fleshman et al. (2000) ArticleTitleFecal Incontinence Quality of Life scale: quality of life instrument for patients with fecal incontinence Dis Colon Rectum 43 9–16 Occurrence Handle1:STN:280:DC%2BD3c3ntFahtw%3D%3D Occurrence Handle10813117

    CAS  PubMed  Google Scholar 

  15. TH Rockwood JM Church JW Fleshman et al. (1999) ArticleTitlePatient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index Dis Colon Rectum 42 1525–32 Occurrence Handle1:STN:280:DC%2BD3c%2FnvVKgsg%3D%3D Occurrence Handle10613469

    CAS  PubMed  Google Scholar 

  16. R Nelson (2004) ArticleTitleA systematic review of medical therapy for anal fissure Dis Colon Rectum 47 422–31 Occurrence Handle10.1007/s10350-003-0079-5 Occurrence Handle14994109

    Article  PubMed  Google Scholar 

  17. BB Mentes O Irkorucu M Akin S Leventoglu E Tatlicioglu (2003) ArticleTitleComparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure Dis Colon Rectum 46 232–7 Occurrence Handle10.1007/s10350-004-6528-y Occurrence Handle12576897

    Article  PubMed  Google Scholar 

  18. CS Richard R Gregoire EA Plewes et al. (2000) ArticleTitleInternal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group Dis Colon Rectum 43 1048–57 Occurrence Handle1:STN:280:DC%2BD3cvitVSgsg%3D%3D Occurrence Handle10950002

    CAS  PubMed  Google Scholar 

  19. P Reissman (1996) ArticleTitleSignificance of anal canal ultrasound before sphincterotomy in multiparous women with anal fissure [letter] Dis Colon Rectum 39 1060 Occurrence Handle1:STN:280:BymA1M%2FmvVw%3D Occurrence Handle8797661

    CAS  PubMed  Google Scholar 

  20. AH Sultan MA Kamm CN Hudson JM Thomas CI Bartram (1993) ArticleTitleAnal-sphincter disruption during vaginal delivery N Engl J Med 329 1905–11 Occurrence Handle10.1056/NEJM199312233292601 Occurrence Handle1:STN:280:ByuD28jitlE%3D Occurrence Handle8247054

    Article  CAS  PubMed  Google Scholar 

  21. AH Sultan MA Kamm CN Hudson (1994) ArticleTitlePudendal nerve damage during labour: prospective study before and after childbirth Br J Obstet Gynaecol 101 22–8 Occurrence Handle1:STN:280:ByuC38fmvFA%3D Occurrence Handle8297863

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

    Sergio Casillas M.D., Tracy L. Hull M.D., Massarat Zutshi M.D., Radzislaw Trzcinski M.D. & Jane F. Bast R.N.

  2. Department of Biostatistics, The Cleveland Clinic Foundation, Cleveland, Ohio

    Meng Xu M.S.

Authors
  1. Sergio Casillas M.D.
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  2. Tracy L. Hull M.D.
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  3. Massarat Zutshi M.D.
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  4. Radzislaw Trzcinski M.D.
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  5. Jane F. Bast R.N.
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  6. Meng Xu M.S.
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Correspondence to Tracy L. Hull M.D..

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Casillas, S., Hull, T., Zutshi, M. et al. Incontinence After a Lateral Internal Sphincterotomy: Are We Underestimating It?. Dis Colon Rectum 48, 1193–1199 (2005). https://doi.org/10.1007/s10350-004-0914-3

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  • DOI: https://doi.org/10.1007/s10350-004-0914-3

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