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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Surgery a

DEAR READER: In a past column, I discussed non-surgical treatments for fecal incontinence. Today, I’ll discuss surgical options.

When everything works properly, feces move from the colon into the rectum, which sits at the end of the digestive tract. The rectum has walls that stretch to hold the stool. Two circular muscles are present in the last inch of the rectum, or anal canal. The internal anal sphincter, which is not under your conscious control, is squeezed shut most of the time to prevent leakage. The external anal sphincter, which you do control, surrounds the internal anal sphincter.

Nerves tell your brain when your rectum is full. That tends to loosen your internal sphincter. It also sends a message to your brain: “If you don’t do something, you’re going to have a bowel movement.” If you choose to delay a bowel movement, your brain sends signals that tighten the external anal sphincter, and holds feces inside. You also tighten a second muscle that loops around the rectum, and holds in the stool.

If things aren’t working properly, you may need surgery to fix the problem. Procedures can involve the following:

Bulking agents. Bulking agents are injected into the anal canal to keep it closed. The procedure is simple. But its effectiveness has not met expectations.

Sacral nerve stimulation. In this minimally invasive surgery, the surgeon inserts a kind of pacemaker. It provides continuous electric stimulation to the muscles of the pelvic floor, and strengthens them.

Sphincteroplasty. During the procedure, the surgeon will reattach damaged ends of the anal sphincter to restore the anus to its proper shape.

Artificial sphincter. The doctor inserts a device. It keeps the anus closed until the person squeezes a pump to open it.

Colostomy. Usually last resort. This procedure reroutes feces from the rectum and anal canal.

While surgical techniques can be effective, non-surgical techniques often provide sufficient relief that surgery is not required.