SUJATHA RAJAN, MD NEERAJ KOHLI, MD, MBA Dr. Rajan is a fellow and Dr. Kohli is chief, division of urogynecology and reconstructive pelvic surgery, Brigham and Women’s Hospital, Boston, Mass. Dr. Kohli is also a member of the OBG MANAGEMENT Board of Editors.
This procedure is associated with significant postoperative complications; many patients require multiple reoperations. Thus, this intervention is useful only in patients with refractory incontinence.
Artificial anal sphincter procedure involves placing a cuff around the anal canal and a pressure-regulating balloon and pump in the labia majora. The cuff remains inflated, thereby occluding the anal canal until the patient experiences a desire to defecate, at which time it is deflated.
Results are encouraging, with initial success rates from 60% to 75%.24,25 However, local infection can be problematic.
Less common procedures include anal encirclement (Thiersch procedure), perianal fat injection, antegrade continence enema, and fecal diversion.
A word on prevention
During childbirth. Strategies that may reduce pelvic floor trauma:
Favor mediolateral over midline episiotomy,
avoid a prolonged second stage of labor and forceps delivery, and
repair anal sphincter lacerations with an overlapping technique.
Also, discuss regular pelvic floor exercises, constipation prevention, weight loss, and smoking cessation with all obstetric patients—especially those with fecal incontinence risk factors.
Debate continues about elective cesarean section in women with occult sphincter injury on postpartum endoanal ultrasound, transient symptoms of fecal incontinence with prior delivery, or overt gas incontinence.26 This practice may have clinical utility, but data are insufficient to recommend it routinely.
The authors report no financial relationships relevant to this article.
