Anal Sphincter Dysfunction After Childbirth and Surgery

Sphincter muscle weakness or injury

Hello Doctor,
I have been experiencing scar pain, a foreign body sensation, fecal incontinence, and leakage after bowel movements since undergoing hemorrhoid surgery postpartum.
After undergoing anorectal manometry and anal ultrasound, the doctor informed me that my sphincter function is worse than that of normal individuals.
The left levator ani muscle appears to be less prominent due to prolonged labor and fetal head pressure during delivery.
The sphincter has adequate contraction strength but insufficient tension.
The ultrasound images showed that the left internal anal sphincter appears incomplete—not completely torn, but rather segmented and layered.
There is about one centimeter of subcutaneous tissue in the external anal sphincter replaced by scar tissue.
An MRI report also indicated, "Left levator ani muscle and tissue edema or other causes cannot be ruled out," and "thickening of the left external anal sphincter with anal canal adhesion." After the examinations, the doctor only recommended dietary control and training, and did not suggest repair surgery.

I would like to ask the doctor:
1.
Is there a chance that training the pelvic floor muscles can improve my fecal incontinence and post-defecation leakage?
2.
Regarding the incomplete internal anal sphincter, which is not torn but appears layered, is it truly impossible to perform a repair surgery? The ultrasound shows that the muscle anal ring is different from that of normal individuals; is training really effective?
3.
Will the pain from the scar gradually diminish over time?
4.
What other recommendations can the doctor provide?
I have consulted many doctors who all said there was nothing wrong.
It has been 11 months since my hemorrhoid surgery postpartum, and I feel really helpless facing the pain, foreign body sensation, fecal incontinence, and leakage after bowel movements.
It wasn't until I specifically traveled to the north for anorectal manometry and ultrasound that the doctor informed me that the scar involved muscle during the surgical process, but no further examinations were conducted.
I hope you can provide me with some advice.
Thank you very much.

Niming, 30~39 year old female. Ask Date: 2022/11/01

Dr. Zhang Shuhao reply Surgery

1.
Training the pelvic floor muscles and conservative treatments such as physical therapy have about a 60% chance of improvement.

2.
If conservative treatments are ineffective, sphincter repair surgery is still recommended.
Even if the remaining muscle strength is insufficient, there can still be a certain degree of improvement in incontinence symptoms.
It is advised to have this procedure performed by a more experienced physician at a medical center.

3.
Scar pain may gradually diminish over time.

4.
It is advisable to first consult with a physician who performs hemorrhoid surgery or anal ultrasound to determine the extent of the external anal sphincter injury and whether there is any accompanying damage to the perineal nerve function.
Bring the examination results and imaging data to a medical center for consultation, as sphincter surgery is a specialized field that requires a complete evaluation by an expert before proceeding with surgery.

Reply Date: 2022/11/01

More Info

Understanding anal sphincter dysfunction after childbirth and surgery can be complex, particularly when there are complications such as scarring, pain, and incontinence. Your situation, as described, involves several factors that can contribute to these symptoms, including the surgical intervention for hemorrhoids and the potential impact of childbirth on pelvic floor muscles.

1. Pelvic Floor Muscle Training: Engaging in pelvic floor muscle training, often referred to as Kegel exercises, can indeed help improve symptoms of fecal incontinence. These exercises strengthen the pelvic floor muscles, which support the bladder and bowel. While results can vary, many individuals experience improvements in their ability to control bowel movements and reduce leakage. It is essential to perform these exercises correctly and consistently, and working with a physical therapist specializing in pelvic health can provide guidance and enhance the effectiveness of your training.

2. Condition of the Internal Sphincter: The description of your internal sphincter as "not complete" but not completely torn suggests that there may be some structural integrity remaining, albeit compromised. Surgical repair of the sphincter can be considered in cases of significant dysfunction, but it depends on the specific anatomy and the degree of impairment. If the muscle appears layered or thickened due to scarring, it may complicate surgical options. A thorough evaluation by a colorectal surgeon who specializes in sphincter repair may provide additional insights into whether surgical intervention could be beneficial for you.

3. Scar Pain and Healing: Scar tissue can take time to mature and may cause discomfort for several months post-surgery. Over time, many individuals find that scar pain diminishes as the tissue heals and becomes more pliable. However, if the pain persists or worsens, it may be worthwhile to explore options such as physical therapy, massage, or other modalities aimed at reducing scar tissue sensitivity and improving tissue mobility.

4. Additional Recommendations: Given the complexity of your symptoms and the impact they have on your quality of life, it may be beneficial to seek a multidisciplinary approach. This could include:
- Pelvic Floor Physical Therapy: A specialized therapist can provide tailored exercises and techniques to help alleviate symptoms and improve muscle function.

- Dietary Adjustments: Maintaining a diet high in fiber and adequate hydration can help manage bowel movements and reduce straining, which may alleviate some symptoms.

- Pain Management: If pain persists, discussing options for pain management with your healthcare provider may be helpful. This could include medications, topical treatments, or alternative therapies.

- Regular Follow-Up: Continuous monitoring of your condition is essential. If symptoms do not improve or worsen, further diagnostic testing or referrals to specialists may be necessary.

In conclusion, while the journey to recovery may feel overwhelming, there are avenues to explore that can lead to improvement. Engaging with healthcare professionals who understand the intricacies of pelvic floor dysfunction and are willing to work with you on a comprehensive management plan is crucial. Remember, you are not alone in this, and seeking support from others who have experienced similar challenges can also be beneficial.

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