About Incontinence - Treatment / Management Options - Artificial Sphincter Surgery for Fecal Incontinence
Medical Reviewer: Christine Norton, PhD, MA, RN
Everyone has a pelvic floor: it is a hammock of muscles that lies in your pelvis, supporting the organs (bowel, bladder, and - in women - the uterus) in that area and keeping them in the correct place. In your pelvic floor are a few muscles that are called "sphincters". There is an internal and external sphincter surrounding the anus. These anal sphincters naturally contract around the rectum and keep the fecal matter inside your body until you relax the sphincters at a socially-acceptable time (generally when you're using a toilet). As the urge to defecate increases, you can contract your sphincters to gain more control.
Surgery to implant an artificial sphincter involves placing an inflatable sphincter around the anus. A pump (placed inside the body in the labia or scrotum) is used to deflate the device, allowing fecal matter to pass through at the appropriate time. The device automatically refills after ten minutes, once again closing off the rectum.
Men or women with fecal incontinence following sphincter damage may be interested in this surgery. Sphincter damage can occur as the result of episiotomy, childbirth, or treatment of prostate cancer.
There are relatively few treatment options available for fecal incontinence. When other treatments haven't been successful, some individuals feel that the potential benefits of this surgery outweigh the risks.
This surgery has a relatively low success rate, and a review done by the Cochrane Collaboration (a well-respected group which reviews medical studies) found that there was not enough evidence to determine that surgery for fecal incontinence does more good than harm when compared to non-surgical interventions.
As with any surgery, there are certain risks associated, especially the risk of infection.
There is a risk of tissue erosion at the site of the implant.
There are high rates of complications and device malfunction associated with the implantation of an artificial sphincter for the treatment of fecal incontinence.
Christine Norton PhD, MA, RN, is the Burdett Professor of Gastrointestinal Nursing King’s College, London & Nurse Consultant (Bowel Control) at St Mark’s Hospital. She trained as a nurse at St George’s Hospital in London after reading history at Cambridge University . She was one of the first continence nurse specialists in the UK and was the first Secretary of the Association for Continence Advice. Later she was founder and Director of the UK Continence Foundation. For the past ten years Christine has returned to clinical practice and has worked at St. Mark's Hospital the UK ’s leading colorectal hospital, where she heads a nurse-led service for patients with faecal incontinence and constipation. She was awarded a PhD by London University in 2001 for a study of biofeedback for faecal incontinence.
Her book “Bowel Continence Nursing” was published in 2004. 2005 saw the launch of new research and teaching venture, the Burdett Institute of Gastrointestinal Nursing with Christine as the first Director.
She has co- founded and co-chaired the International Continence Society’s Continence Promotion Committee, had represented nursing on the ICS Board, chairs the International Consultation on Incontinence faecal incontinence committee, the Royal College of Nursing Gastroenterology & Stoma Care Forum and is an editor for the Cochrane incontinence group. She is chair of the National Institute of Clinical Excellence guideline on faecal incontinence, published by the UK government in 2007.
Page last modified 29 May 2011