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Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas-Dhakuria

Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas

Surgical Treatment of Anal Incontinence and Recto Vaginal Fistulas Surgery in Dhakuria

Bowel incontinence, another name for anal incontinence, is the inability to control or regulate a bowel movement (poop). Waste (or faeces) seeps out of you without warning. Treatment options may involve weight loss, exercise, medication, or surgery, depending on the underlying reason.

Medication and diet adjustments may not always be enough to control anal incontinence. Surgery may be necessary to treat faecal incontinence if an underlying issue, such as rectal prolapse or sphincter injury from delivery, is present.

On the other hand, a rectovaginal fistula is an abnormal connection between the woman’s rectum and vagina. A condition caused during childbirth or surgery can result in significant discomfort for the patient. Due to this abnormal connection, stool and gas can leak out into the vagina. However, the condition is treatable with surgery. If you are looking for Surgical treatment of anal incontinence and recto vaginal fistulas in Dhakuria, visit Manipal Hospitals. 

FAQ's

Surgery may be necessary to treat faecal incontinence if an underlying issue, such as rectal prolapse or sphincter injury from delivery, is present. Among the choices are:

  • Sphincteroplasty is a procedure where damaged anal sphincter muscles are resealed together, causing the anal entrance to constrict. It was once the most common procedure for faecal incontinence. 

  • Artificial Anal Sphincter Implantation involves implanting a prosthetic around the anus, similar to a typical anal muscle. Sacral nerve stimulation is used to implant a neurotransmitter under the skin in the upper butt area, which affects the pelvic floor, sphincter, and bladder muscles.

  • Antegrade Colonic Enema (ACE) Surgery: A surgeon creates a small passageway connecting the colon to the belly skin and installs a tube for daily washout or enema to remove waste from the colon.

  • A Colonoscopy is a surgical procedure where a surgeon creates an opening in the abdomen to bring the colon to the skin's surface and attaches a pouch to collect stool around the opening.

Bowel motions are regulated by two anal muscles. When damage or a deficiency occurs in this muscular circle, anal Sphincteroplasty is the treatment of choice. Sphincteroplasty is done to strengthen or repair the muscles that govern bowel movements—the anal sphincter muscles. The procedure is frequently done to address faecal incontinence and repair the anal sphincter brought on by anal muscles injured during delivery. Anaesthesia, either general or regional, is used for the procedure. 
 

Sphincteroplasty is indicated when there is:

Damage to the anal sphincter: damage is frequently brought on by surgical operations, accidents, and obstetric injuries sustained during childbirth, particularly in vaginal births.

Age-related weakening of the anal sphincter: Anal incontinence can result from the anal sphincter's muscles becoming weaker with age. In certain situations, Sphincteroplasty can aid in strengthening the muscle and regaining function.

Neurologic injury: The nerves that regulate the anal sphincter can be damaged by certain medical diseases, such as a stroke or spinal cord injury, which can result in faecal incontinence.

Chronic diseases: Over time, some chronic diseases like multiple sclerosis or diabetes can harm the nerves that regulate the sphincter, which can result in faecal incontinence.
 

  • With an ACE technique, the patient can flush out all of their faeces, beginning from the bottom of the colon. This results in a controlled bowel movement for the patient.

  • The patient has a little incision (ostomy) done in their lower abdomen or belly button.

  • It is possible to make this aperture so tiny that it hardly shows at all.

  • To induce a bowel movement and flush away the saline solution in the patient's colon, an ostomy is used. 

  • Depending on how frequently cleaning is required, this can be done every day, every other day, or two to three times each week.

  • Maintaining a routine will assist in keeping the patient's pants clean in between flushes.

A tunnel-like hole that forms between your vagina and rectum is called a rectovaginal fistula. The portion of your digestive system that joins your anus to your big intestine (colon) is called your rectum. It retains gas and faeces until your body lets them out.

Damage to the vaginal tissue results in tissue death and the formation of a hole, or fistula, referred to as a rectovaginal fistula. Gas and faeces can enter your vagina through this orifice.
 

Rectovaginal fistulas can be caused by:

  • Prolonged labour, tears in the vagina during childbirth, or an episiotomy (an incision created by your healthcare practitioner) to assist you in delivering your baby.

  • Operations on the abdomen or pelvis, such as Hysterectomy and C-sections.

  • Colorectal (colon) cancer or cervical cancer

  • Inflammatory bowel disorders, which may include ulcerative colitis and Crohn's disease.

  • Colon infections.

  • Radiation treatment to the lower abdomen. 

Recto-vaginal fistula complications might include:

  • Anal incontinence

  • Recurring urinary tract or vaginal infections

  • Irritation or inflammation of the skin surrounding your anus, the perineum, or your vagina

  • Problems with intimacy and embarrassment

A colorectal surgeon, a gynaecological surgeon, or both operating in a team may perform the surgery to seal a fistula. The objective is to cut out the fistula tunnel and suture the healthy tissue together to seal the entrance.

Surgical options include:

  • Fistula removal: the fistula tunnel is eliminated, and the anal and vaginal tissues are healed.

  • Tissue graft: the surgeon makes a flap from adjacent healthy tissue after removing the fistula. The fix is concealed by the flap. There are several options available that include the use of tissue or muscle flaps from the rectum or vagina.

  • Repairing the muscles of the anal sphincter: these muscles are restored if they were harmed by the fistula, during vaginal birth, or by radiation or Crohn's disease-related scarring or tissue damage.

  • Colostomy before fistula repair: In complicated or recurring situations, performing a Colostomy is preferred before fistula repair. It is a surgical operation where waste is redirected from your rectum via a hole in your abdomen. In extremely rare circumstances, a Colostomy may be required permanently or only temporarily. 

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