Surgical Options for Fecal Incontinence
Surgery for fecal incontinence exists, but I very rarely recommend it. Most women get real relief from simpler treatments and from sacral neuromodulation, a minimally invasive procedure. I think about open surgery only after everything else has been tried.
Why surgery is rarely the answer
The simpler treatments work well for a lot of women. Diet changes, pelvic floor physical therapy and sacral neuromodulation often control leakage on their own.
Open surgery also carries more risk of complications than those treatments do. And some of the operations don’t hold up well over time. A repair can help at first and then lose ground over the next few years.
What I try first
Before we talk about any operation, you should have tried the conservative treatments. For most women that means some mix of diet changes, bowel retraining and pelvic floor physical therapy. The Eclipse™ System is another option at this stage.
The next step: sacral neuromodulation
If those don’t give you enough relief, the next step is sacral neuromodulation, sometimes called a “bowel pacemaker.” A small implanted device stimulates the nerves that control your bowel. It’s the preferred first choice among procedures for fecal incontinence, and it can work even when the anal sphincter muscle is damaged.
You also get to test it before anything permanent goes in. Because of that, most women reach this step long before open surgery comes up at all.
The operations, when nothing else has worked
In the rare case where every other treatment has failed, there are three operations to consider. Each one has real limits.
Sphincteroplasty
This operation repairs a torn or damaged anal sphincter muscle. It often helps in the short term, but control tends to slip over the following years. The risk of complications is meaningful, and wound infection is one of them. Even when a sphincter tear is present, I generally prefer sacral neuromodulation for most patients.
Artificial bowel sphincter
Here a surgeon implants a device to control bowel movements. Long-term success is limited, and complication rates are high. This is not a procedure I perform.
Fecal diversion (ostomy)
A surgeon makes an opening in the belly so stool passes into a bag. I save this for severe cases that haven’t responded to anything else. It changes your daily routine, but most women who need one report a good quality of life afterward.
Before you agree to any of these, you and your surgeon should go through the risks and benefits of that specific operation in detail.
How I approach it
I treat fecal incontinence one step at a time. We start with the conservative treatments, move to sacral neuromodulation if those aren’t enough, and keep adjusting the plan as we see what helps. I recommend surgery only in the rare case where you need it.
Next steps
If you’re living with fecal incontinence, you have several good options to try before surgery, and many women improve a lot without ever needing an operation. At your first visit I’ll go over your symptoms and what you’ve already tried, and we’ll build a plan around your goals.
References
- Brown HW, Dyer KY, Rogers RG. Management of Fecal Incontinence. Obstetrics & Gynecology. 2020. doi:10.1097/AOG.0000000000004054
- Meyer I, Richter HE. Accidental Bowel Leakage/Fecal Incontinence: Evidence-Based Management. Obstetrics and Gynecology Clinics of North America. 2021. doi:10.1016/j.ogc.2021.05.003
- Meyer I, Richter HE. Impact of Fecal Incontinence and Its Treatment on Quality of Life in Women. Women’s Health (London, England). 2015. doi:10.2217/whe.14.66
- DeLancey JOL, Miller NF, Berger MB. Surgical Approaches to Postobstetrical Perineal Body Defects (Rectovaginal Fistula and Chronic Third and Fourth-degree Lacerations). Clinical Obstetrics and Gynecology. 2010. doi:10.1097/GRF.0b013e3181cd4222
- Goldman HB, Lloyd JC, Noblett KL, et al. International Continence Society best practice statement for use of sacral neuromodulation. Neurourology and Urodynamics. 2018. doi:10.1002/nau.23596