Will My Sphincter Muscle Heal After Fistula Surgery?

Fistula surgery with sphincterotomy?

I had a fistula surgery last week, and the fistula is less than one centimeter from the anal opening.
After the surgery, I realized that the sphincter muscle was cut at the anal opening, and now it feels like a broken rubber band.
Will the sphincter muscle heal back? It used to feel tight like a ring.
Thank you.

Kyle, 50~59 year old female. Ask Date: 2022/01/24

Dr. Zhang Shuhao reply Surgery

The anal sphincter is divided into the internal and external sphincters.
In fistula surgery, to achieve a clean excision, a portion of the external sphincter is typically incised, but it is not completely severed, so bowel function should not be affected.
However, due to changes in anal tension post-surgery, there may be a slight feeling of incontinence during diarrhea, which can be managed with medication.
If the initial fistula is located within one centimeter of the anal opening, the risk of complications is very low, so there is no need for excessive concern.
Wishing you a speedy recovery.

Reply Date: 2022/01/24

More Info

After undergoing fistula surgery, particularly when the procedure involves cutting into the sphincter muscle, it is natural to have concerns about the healing process and the functionality of the muscle afterward. The sphincter muscle plays a crucial role in maintaining continence, and any surgical intervention in this area can lead to anxiety about potential complications or changes in function.

Firstly, it is important to understand that the sphincter muscle has a remarkable ability to heal. The healing process typically involves the regeneration of muscle fibers and the formation of scar tissue. While the muscle may not return to its exact pre-surgery state, many patients experience significant recovery in function over time. The extent of healing can depend on several factors, including the size of the incision, the technique used during surgery, and individual healing responses.

In your case, since the fistula was located less than one centimeter from the anus and involved cutting into the sphincter, it is likely that the surgical team took measures to minimize damage and promote healing. The sensation you describe—similar to a "broken rubber band"—is not uncommon. Initially, you may feel a difference in tightness or control, but this often improves as the muscle heals and adapts.

Post-operative care is crucial for optimal recovery. Here are some recommendations to support your healing process:
1. Follow-Up Appointments: Regular follow-ups with your surgeon are essential. They can monitor your healing progress and address any concerns you may have.

2. Pelvic Floor Exercises: Once cleared by your healthcare provider, engaging in pelvic floor exercises (often referred to as Kegel exercises) can help strengthen the sphincter muscle and improve control. These exercises involve contracting and relaxing the muscles used to stop urination.

3. Diet and Hydration: Maintaining a high-fiber diet and staying well-hydrated can help prevent constipation, which is crucial for avoiding additional strain on the healing area.

4. Avoid Straining: It’s important to avoid straining during bowel movements, as this can put undue pressure on the surgical site and the sphincter muscle.

5. Pain Management: If you experience discomfort, consult your healthcare provider about appropriate pain management strategies. Managing pain effectively can help you engage in activities that promote healing.

6. Monitor Symptoms: Keep an eye on any unusual symptoms, such as increased pain, bleeding, or changes in bowel habits. If you notice any concerning signs, contact your healthcare provider promptly.

In summary, while the sphincter muscle may not return to its original state, it has the potential to heal and regain function over time. With proper care and monitoring, many patients find that they can achieve satisfactory outcomes following fistula surgery. If you have ongoing concerns about your recovery or the functionality of your sphincter muscle, do not hesitate to discuss them with your surgeon or a specialist in colorectal health. They can provide tailored advice and reassurance based on your specific situation.

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