Many women find relief through diet changes and medicines. Sometimes women may need surgery to obtain relief from accidental bowel leakage, such as to repair a torn anal sphincter muscle. Rarely, doctors treat constipation with surgery.
Bowel control surgery is a big decision. Consult with a colorectal surgeon or urogynecologist. Consider getting a second opinion before making your decision.
ABL Procedures & Surgery
Percutaneous tibial nerve stimulation (PTNS): outpatient office procedure in which a slim needle electrode is temporarily inserted near your ankle and connected to a battery-powered stimulator. This is like a combination of acupuncture and a TENS unit. The impulses travel through the tibial nerve and then to the sacral nerve plexus. Each treatment lasts for approximately 30 minutes weekly for usually up to 12 weeks. This has been shown to decrease fecal incontinence in the short term. It can also help urinary urgency incontinence. Potential side effects include discomfort and pain near the stimulation site.
Sacral nerve stimulation (SNS): an implantable system (similar to a heart pacemaker) that sends mild electrical impulses to the sacral nerves. It can be helpful for both ABL and chronic constipation in patients who have failed other options. It typically involves a one- to two-week trial prior to placement of the permanent lead (a thin wire) and stimulator. If the trial period is not successful, the permanent device will not be implanted. Because the device is metal, you would not be able to have MRIs in this area if the device is implanted.
- Fecal incontinence: Studies found that women who had SNS experienced fewer episodes of fecal incontinence compared to women who were treated with other medical therapies. Some women even regained full control of the bowels. Risks of this procedure include infection and pain/discomfort of the lead or stimulator. Some women require additional surgeries.
- Constipation: SNS helps to speed transit time of feces through the colon. SNS may also reduce the abdominal pain and bloating of constipation.
- Read more about nerve stimulation for pelvic floor disorders.
Overlapping Anal Sphincteroplasty
Some women have injury to the anal sphincter muscles following vaginal delivery. Repair of torn anal sphincter muscles with surgery is possible for some women. However, for many women this surgery has a low success rate. Therefore, it is not an option for everyone. For example, an overlapping anal sphincteroplasty is more successful when the nerves are working properly.
Injectable Anal Bulking Agents
Bulking agents are injected in and around the anal canal to help hold in stool for people with ABL. Dextranomer hyaluronic acid (Solesta®), is FDA approved for this problem. It is thought to narrow the anal canal, which helps to improve control of stool by the anal sphincter muscles.
Bulking agents can be effective for women with moderate symptoms. This option does not work for everyone. Studies have found bulking agents to be effective for about half of the women who choose this option. It may take 3 to 6 months before improvements are seen. In addition, some women need more than one injection to see improvements. This treatment may not be covered by your insurance.
The procedure is typically done in an outpatient setting, similar to a colonoscopy. Mild or moderate discomfort or pain in the rectum or anus is common. In addition, you may experience some mild bleeding or spotting in the rectum. Ask your doctor about risks and side effects.
Magnetic Anal Sphincter
An emerging treatment is a flexible ring of magnets that is implanted around the anal canal to increase the strength of the anal sphincter. Straining to defecate when you need to normally will separate the beads to allow voluntary passage of stool. This treatment seems to be effective for some patients in the short term, however studies to determine how well this works over time are still underway.
A rectocele is a prolapse of the rectum upward into the vagina, similar to a hernia. If stool is getting “trapped” in the rectocele pouch, it can seeping out later. Repairing the rectocele surgically can sometimes lead to improved bowel emptying.
Significant hemorrhoids may prevent the anus from making a tight seal and lead to stool leakage. Repair of the hemorrhoids can sometimes help reduce this seepage.
If a fistula (abnormal connection between the bowel and vagina) is present, closing the fistula is generally curative when there are no other factors contributing to the anal incontinence.
Rectal Prolapse Repair
If a rectal prolapse is present with a bulge at the anus, there are several surgeries that can be done to repair this. Some of these are done through the abdomen, either with a large incision or with laparoscopic surgery. Other people undergo surgery at the anal opening. Discuss with your colorectal surgeon what is best for you.
When other treatment options have failed for severe ABL, one option is to re-route the bowels so that they empty in a bag rather than through the anus. These are called a colostomy or ileostomy depending on which part of the bowel is brought up to the bag.
Sometimes surgery can help improve bowel emptying for patients with who have constipation due to bowel conditions such as rectoceles and rectal prolapse. However, surgery will not fix the entire problem. You’ll need other treatment options, such as diet and medicines, in combination with surgery—both before and after.