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Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas-Broadway

Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas

Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas in Broadway

To restore the normal function and quality of life of patients suffering from anal incontinence and recto vaginal fistulas, sometimes surgical solutions become the only treatment option available. Anal incontinence, also known as bowel or faecal incontinence, is the inability of the body to control or manage bowel movements (poop), resulting in the accidental leak of faeces with or without gas. It is common among women and is mostly caused during childbirth. Surgery or other conditions, like strokes, can also cause anal incontinence. When conservative treatments fail, surgical intervention is often needed for anal incontinence, which includes techniques such as Sphincteroplasty, Artificial Anal Sphincter, Sacral Nerve Stimulation, Antegrade Colonic Enema surgery, and Colonostomy. 

Rectovaginal fistulas are holes or abnormal connections that develop between the vagina and rectum, resulting in the leakage of stool or gas through the vagina. It often requires surgical intervention to close the fistula, prevent recurrent infections, and maintain the integrity of the pelvic organs. There can be many causes for this condition, but childbirth is one of them. Surgical solutions include repairing the fistula through sutures or other closure methods, using a Tissue Graft, and a temporary or permanent Colostomy. 

Both of these conditions are related, as anal incontinence is also a complication of the rectovaginal fistula. Manipal Hospitals, Broadway, Kolkata, has a team of skilled surgeons who have the precise surgical skills needed for surgical treatment of anal incontinence and recto vaginal fistulas in Broadway. We also provide comprehensive post-operative care to ensure successful treatment outcomes, minimise complications, and ultimately enhance patients’ quality of life.

FAQ's

Vaginal fistulas are holes that can develop between the vagina and other digestive or urinary system organs. These are:

 

  • Rectovaginal Fistulas: This is the abnormal opening between the vagina and rectum.

  • Colovaginal Fistulas: An abnormal opening occurs between the vagina and large intestine (colon).

  • Enterovaginal Fistulas: In this type, the opening is between the vagina and the small intestine.

The rectovaginal fistula is caused by trauma to the vaginal tissue, which stops the blood flow to the tissue, leading to its death. Various causes include:

 

  • Childbirth injuries (prolonged labor, vaginal, or incision tear)

  • Pelvic area cancer (cervical and colorectal cancer)

  • Inflammatory bowel diseases, ulcerative colitis, Crohn’s disease)

  • Abdominal or pelvic surgery

  • Radiation therapy in the pelvic area

  • Colon infections (diverticulitis)

Rectovaginal fistulas are treated according to their location, size, and impact on the surrounding tissues. Generally, surgery is the only solution for repairing fistulas. Its surgical options include:

Repairing the Fistula: The surgeon will use sutures or other closure methods like taking tissue from other parts of the body to form a plug or flap (tissue grafting). This repair can be done either through the abdomen, anus, and rectum or through the vagina, depending on the location of the fistula. 

Advancement Flap Repair: For more advanced fistulas, this technique is used for repairing fistulas using healthy tissue from the rectum or vagina.

Repairing Anal Sphincter Muscles: If childbirth or other conditions cause damage to the sphincter muscles due to a fistula, they will also need to be repaired. 

Colostomy: It is a procedure to divert the stool through an opening in the belly instead of a rectum. The opening is called a stoma, and a bag will collect waste until the fistula heals. It can be temporary, or in rare cases, it may be permanent. It is needed before repairing the fistula in complex or recurrent cases.
 

To fully recover after Rectovaginal Fistula Surgery, follow these precautions:

 

  • Take your medications (antibiotics) as prescribed
  • Avoid having sex or using tampons
  • Prevent constipation and diarrhea by making certain dietary changes (drink plenty of water and eat a high-fiber diet)
  • Keep the area around the surgery as clean as possible 
    • Gently wash with water after vaginal discharge or passing stool
    • Keep the area dry with a clean cloth or towel
    • Don’t rub the area
    • Don't use any type of irritant (soap)
  • Wear loose clothing or cotton underwear

Also, follow all post-operative instructions given by our doctor based on your condition.
 

Damage to the nerves or muscles that help your body poop could be the main cause of anal incontinence. Other causes are:

 

  • Constipation

  • Diarrohea

  • Large haemorrhoids

  • Pelvic organ prolapse

  • Surgery involving the rectum and anus

  • Radiation therapy

  • Crohn’s disease

  • Muscle damage (childbirth, episiotomy)

  • Nerve damage (childbirth, long-lasting constipation, spinal cord injury, diabetes, multiple sclerosis, stroke, repeated straining during bowel movements)

There are two types of anal incontinence:

 

  1. Passive incontinence: In this type, there is an issue of nerves communicating with your muscles. The rectum stretches and is ready to poop, but the body is not responding, leading to the passing of poop without you realizing it. 
  2. Urge incontinence: This is the most common type of anal or fecal incontinence. There is an issue with the muscles controlling your bowel movement. Before you reach the toilet, accidental poop occurs.
     

Various surgeries used to treat anal incontinence are:

 

Sphincteroplasty: This surgery is used to correct damaged anal sphincter muscles by overlapping them and sewing them together on both sides to tighten the anal opening. 

Artificial Anal Sphincter: This makes use of implanting an artificial device around the anus that mimics the action of a normal anal muscle.

Sacral Nerve Stimulation: This technique implants a small device (a neurotransmitter) that sends mild electric impulses to the sacral nerve, which influences the sphincter, bladder, and pelvic floor muscles to do their function. It is most commonly used, especially in cases of nerve damage. 

Antegrade Colonic Enema (ACE) Surgery: This is occasionally used where a small pathway is created from the skin of the abdomen to your bowel. It involves the insertion of a small tube that will be used for daily enema to get rid of poop in your colon.

Colostomy: This is the last resort when other treatment options have failed. An opening is created in the abdomen, and the colon is brought to the surface of the skin. A special pouch is attached to the abdomen to collect stool.

The preparation for both types of surgery includes a thorough medical evaluation with the doctor and a discussion of all medications and supplements you are taking.
Following all pre-operative instructions given by the team, such as fasting or bowel preparation. Arrange for support at home post-surgery and understand all the post-operative care instructions to ensure a smooth recovery. Also, you will be informed about the type of procedure you will be undergoing, its benefits and its risks. Based on your preference, overall health, and medical condition, a decision will be made about the type of surgery you will be undergoing for better outcomes.

Just like other surgeries, Anal Incontinence and Rectovaginal Fistula Surgeries also carry some risks, such as:

  • Bleeding

  • Blood clots in the legs or lung

  • Blockage in the bowel

  • Scarring

  • Postoperative pain

  • Recurrence

  • Damage to the bladder, ureter, or bowel

  • Infection

  • Emotional or psychological impact

Our team follows strict protocols and precise techniques to minimize the risks associated with these surgeries.
 

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