Treatments – IBS Surgery

Do I Need an Operation?

For some problems that cause faecal incontinence it is possible to do an operation. For other problems there is no operation which can help. The anorectal physiology tests and anal ultrasound tests will determine if an operation is likely to help in your case. This will never be something that you MUST have done, it is your choice whether or not to have an operation if one is suggested.

1. Anterior anal sphincter repair
If the external anal sphincter is damaged, and this damage can be seen very clearly and located accurately with the anal ultrasound test, surgical repair may be suggested. The results of sphincter repair operation are usually good, with 4 out of 5 (80%) of people reporting a satisfactory outcome after 2 years, although the longer-term results are probably less good. This is the best treatment currently available for this particular problem, although one person in five is not helped.

2. Other operations

Post-anal Repair Where the sphincter muscle is not actually broken, but the whole pelvic floor area is generally weak and sagging, the surgeon may suggest a post-anal repair. This is done via an incision behind the anus and the muscles are tightened up to give more support. About one in four patients have good bowel control in the long term after this operation.

Rectal Prolapse Where the tests and examination have found that you have a rectal prolapse, this can be repaired and the rectum fixed back in place. Your surgeon will discuss with you whether it will be better to do this repair through the anus (without any external incision Delormes procedure), or though an incision in your abdomen (abdominal rectopexy).

Other operations for faecal incontinence may sometimes be suggested in some circumstances.

New Developments
For patients with more extensive sphincter damage, or when previous surgery has failed, or for those who were born with little or no anal sphincter, it is possible to construct a new sphincter. Only people with very severe faecal incontinence, who cannot lead a normal life because of it, are likely to be suitable for this at present.
Artificial bowel sphincter
Recently an artificial bowel sphincter made from medical silicone has been developed and implanted. The artificial sphincter is an inflatable cuff which is implanted around the anus to keep it closed. When you want to open your bowels there is a small pump which you press to let the cuff down and allow stool to pass out of the anus. This only available in very specialised hospitals. We do not know yet how successful this is likely to be in the long term.
Dynamic graciloplasty
An alternative operation is called the dynamic graciloplasty. The surgeon takes the gracilis leg muscle from the inner thigh and wraps it around the anus to form a new sphincter. Results are best if this is combined with implantation of a small electrical stimulator which stimulates the muscle to keep it closed at all times except when you want to empty the bowel. Again, this is only done in specialist centres and it is too early to know what the long term results will be.
Sacral nerve stimulation
It is possible to implant a small electrical stimulator to stimulate the nerves that are at the bottom of the spine and help the sphincter muscles to work. This has been used for many years for bladder problems and more recently has been used for the bowel. At the moment this is quite new and it is not certain which people are the most likely to be helped and if the effects will last for many years. It is not likelty to help if the sphincter muscles are very damaged. The technology is the same as a heart pacemaker. A small battery-operated stimulator is implanted under the skin (usually in the buttock or abdomen), with wires that stimulate the nerves at the base of the spine. Usually, temporary stimulation is tried for 2-3 weeks to see if it helps before proceeding to a permanent implant.
The ACE operation (Antegrade Continence Enema)
Some people who have both constipation and faecal incontinence benefit from the ACE operation. This operation creates a small stoma into the right side of the bowel to allow you to wash out the bowel (usually while sitting on the toilet). This is most commonly used for people with major nerve problems such as spina bifida. 
Will I need a bag?
For a few people with severe bowel leakage, which has failed to improve in spite of all attempts at treatment, the decision to have a stoma (colostomy) may be a positive one which enables a return to a more normal life style. While this decision is obviously a major one, and only to be taken after extensive discussion and counselling with a stoma care nurse, some people prefer a stoma to uncontrolled bowel leakage.

A stoma operation brings the end of the bowel out onto the wall of your abdomen, so that you can wear a bag to collect the stools. The modern bags are small and discrete, and contain any smells, so that you can carry on with your life without worrying about having an accident. Other people would not be aware that you have a bag.

Many people find the idea of a stoma or bag very frightening. It is important to understand that this will never be something that you must have done for incontinence, it will always be your choice and decision. If a stoma has been suggested for you, make sure that you see a stoma care nurse, who will give you a lot more information and answer any questions you may have.