Everyone has a pelvic floor: it is a hammock of muscles that lies in your pelvis, supporting your internal organs in that area (bowel, bladder, and – in women – the uterus) 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 sphincter muscles 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 (or squeeze) your sphincters to gain more control. When you cannot control these sphincter muscles, bowel incontinence (also called accidental bowel leakage or fecal incontinence) may happen.
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 bowel incontinence following sphincter damage may be interested in this surgery. Sphincter muscle damage can occur as the result of episiotomy, childbirth, or treatment of prostate cancer.
There are relatively few treatment options available for bowel 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 with it, especially the risk of infection. There is also a risk of tissue erosion at the site of the implant. In addition, there are high rates of complications and device malfunction associated with the implantation of an artificial sphincter for the treatment of bowel incontinence.
Medical Reviewer: Christine Norton, PhD, MA, RN
Professor Norton is Professor of Nursing at King’s College London & Imperial College Healthcare NHS Trust, London. She is also Nurse Consultant, bowel control, at St. Mark’s Hospital in London. She has been working with people with incontinence for over 30 years in a variety of settings. She has an extensive research output on ways of helping people with faecal incontinence, as well as teaching both nationally and internationally. She is the author of the book Nursing for Continence, co-editor of the book Bowel Continence Nursing, and has authored or co-authored articles in such prestigious journals as The Lancet, Spinal Cord, British Journal of Surgery, Journal of Advanced Nursing, Nursing Times, American Journal of Nursing, Diseases of the Colon and Rectum, and many others. Professor Norton chaired the UK national guideline and international groups on managing faecal incontinence. Dr. Norton was one of the first continence nurse specialists in the UK and was the first Secretary of the Association for Continence Advice. Later she founded and was Director of the UK Continence Foundation. She was awarded a PhD by London University in 2001 for a study of biofeedback for faecal incontinence. She has co-founded and co-chaired the International Continence Society (ICS) Continence Promotion Committee, has represented nursing on the ICS Board, chairs the International Consultation on Incontinence (ICI) faecal incontinence committee, the Royal College of Nursing Gastroenterology & Stoma Care Forum and has served as an editor for the Cochrane Incontinence Group.