Post-Surgery Incontinence After Anal Fissure Treatment: What to Expect

Incontinence after anal fissure surgery?

Hello Dr.
Ke,
I have undergone sentinel tag and anal sphincter relaxation surgery due to chronic anal fissures.
It has been about a month and a half since the procedure, and I am still experiencing discomfort and episodes of incontinence.
I would like to ask the following questions:
1.
What is the normal recovery time for sentinel tag and anal sphincter relaxation surgery? I am currently one and a half months post-op, and I still feel a stabbing pain at the incision site, along with a persistent urge to use the restroom.
Is this normal?
2.
After the surgery, if my bowel movements are not well-formed, I experience leakage.
Is this normal? Could it be due to excessive removal of the sphincter? I find that my sensation of needing to defecate has diminished, similar to the sensation of passing gas, and I only feel it when the stool is near the anal opening, which leads to accidental incontinence.
Is this common after surgery, and how long will it take to return to normal?
3.
Previously, there were many anal folds obscuring the anal opening, but post-surgery, the folds are less pronounced, and there is a small opening less than 2mm in size through which I can see the internal intestine.
This is different from the original shape of my anus.
Is this normal? It seems like there is a lack of closure at the anus; when I perform Kegel exercises, I can close the opening, but it reappears when I relax.
4.
If this incontinence is a result of the surgery, what can I do to improve the situation? Can Kegel exercises help? Or should I consider further evaluation for another surgery? Since my incision is still painful, I want to inquire about future directions before proceeding with follow-up consultations.
5.
Does the removal of the anal sphincter affect the sensation of urination and ejaculation? I have noticed a significant decrease in the strength of my urine flow post-surgery.
Is this normal?
6.
In general surgical procedures involving sphincter removal, is there a standardized quantitative measure for the amount removed? For example, is there a guideline such as removing one-third? I am concerned that too much may have been excised.
7.
Is it standard practice during surgery to specifically pull the rectal skin to the anal opening to increase the circumference of the anus?
These are the issues I am facing.
I have been in pain for a long time and am quite worried, so I am seeking your valuable advice.
Thank you for taking the time to read and respond to my concerns.

Jiu Xiansheng, 40~49 year old female. Ask Date: 2023/06/29

Dr. Ke Fangxu reply Surgery

1.
Generally, healing can take about a month; if pain persists, it is advisable to consult the surgeon to check for any abnormalities.

2.
Postoperatively, mild incontinence may occur due to incomplete healing of the wound, which is caused by sensitivity and irritation of the incision.
Normal function should return once the wound heals; if there is no improvement, a follow-up with the physician is necessary.

3.
Without a physical examination, it is impossible to determine if there is an issue; it may also be due to incomplete wound healing.

4.
It is not yet possible to confirm if incontinence is present, so discussing treatment at this stage is not meaningful.
Typically, oral medications and Kegel exercises are prescribed, but a definitive diagnosis must be established first.

5.
It should not be a problem.

6.
Generally, two-thirds of the internal sphincter is incised.

7.
Anal stenosis may warrant additional anal reconstructive surgery; this procedure does not involve pulling the rectum out but rather involves pulling the skin at the anal opening inward.

Reply Date: 2023/06/29

More Info

Post-surgery incontinence following anal fissure treatment, particularly after procedures like anal sphincter relaxation and sentinel tag removal, can be concerning and frustrating for patients. Here’s a comprehensive overview of what you might expect during your recovery, along with answers to your specific questions.

1. Recovery Time: The recovery period after anal surgery can vary significantly among individuals. Generally, it may take anywhere from a few weeks to several months for complete healing. The presence of pain or discomfort, including a stabbing sensation at the surgical site, can be normal during the initial recovery phase. However, if these symptoms persist beyond a few months or worsen, it’s essential to consult your surgeon.

2. Bowel Movements and Incontinence: Experiencing leakage or incontinence, especially with unformed stools, can occur post-surgery. This may be due to the surgical alteration of the anal sphincter, which can affect its ability to maintain closure. If too much of the sphincter muscle was removed, it could lead to increased incontinence. It’s not uncommon for patients to report a change in bowel sensation, feeling less aware of the need to defecate until it’s too late. This symptom can improve over time, but if it persists, further evaluation may be necessary.

3. Changes in Anal Appearance: Post-surgical changes in the appearance of the anal area, such as diminished folds or a small opening, can occur. The visibility of internal structures may be alarming, but it can be a part of the healing process. However, if you notice significant changes or if the area does not seem to be healing properly, it’s crucial to discuss these concerns with your surgeon.

4. Improving Incontinence: Kegel exercises, which strengthen the pelvic floor muscles, can be beneficial in improving incontinence. They may help regain some control over bowel movements. However, if the incontinence is severe or does not improve with conservative measures, a follow-up evaluation may be warranted to assess the need for further intervention.

5. Impact on Urination and Sexual Function: Surgical alterations to the anal sphincter can sometimes affect urinary function and sexual sensations. A decrease in urinary stream strength can occur, but this should be evaluated in the context of your overall recovery. If you notice significant changes in urination or sexual function, it’s important to bring these up with your healthcare provider.

6. Sphincter Resection Standards: There are no universally fixed standards for the amount of sphincter muscle that should be removed during surgery, as this can depend on the specific circumstances of each case. Surgeons typically aim to preserve as much function as possible while addressing the fissure. If you have concerns about excessive removal, discussing this with your surgeon can provide clarity.

7. Surgical Techniques: In some cases, surgeons may perform techniques to enhance the anal canal’s circumference, which can help with bowel control. However, this is not always standard practice and depends on the individual’s anatomy and the specifics of the surgery performed.

In summary, while some discomfort and changes in bowel habits are expected after anal surgery, persistent symptoms warrant further evaluation. It’s crucial to maintain open communication with your healthcare provider, who can guide you through your recovery and address any complications or concerns you may have. If your symptoms do not improve or worsen, do not hesitate to seek further medical advice. Your health and comfort are paramount, and there are options available to help you regain normal function.

Similar Q&A

Post-Surgery Incontinence and Recovery Time After Anal Fissure Surgery

Hello Dr. Ke, I previously inquired about experiencing some incontinence after my anal fissure surgery. During my follow-up appointment, the doctor informed me that the sphincter muscle was not excised. Instead, debridement and diamond-shaped suturing were performed at the 6 o&#...

Dr. Ke Fangxu reply Surgery
1. All surgeries will leave scars, especially if the surgical area is extensive. Mild tingling is also normal. The scars around the anus will typically heal completely within 1-2 months. Due to the lack of aesthetic concerns, scar removal treatments are generally less common in t...

Post-Surgery Concerns After Anal Fissure Repair: What to Expect

Hello Dr. Ke, I underwent anal fissure surgery in November of last year (2005), and it has been over five months since then. I found information online suggesting that anal fissure surgery typically involves cutting the sphincter muscle. When I asked my doctor about it, he mentio...

Dr. Ke Fangxu reply Surgery
Hello: In response to your question, anal fissures do require sphincterotomy surgery, but not all anal fissures necessitate surgery. It's similar to how not every cold develops into pneumonia. Surgery is only recommended if the pain from the anal fissure is unbearable and ca...

Post-Surgery Discharge After Anal Fissure Treatment: What to Expect

Dear Dr. Ko, I underwent surgery for an acute thrombosis on October 31. Less than ten days later, I developed a granulation tissue that was larger than the thrombosis itself, and it was very painful during those days. During my follow-up appointment, the doctor cut it without a...

Dr. Ke Fangxu reply Surgery
There are two different surgical methods for thrombosed hemorrhoids: incision and excision. It is unclear which one you underwent, but generally, only excision surgery can lead to the complication of granuloma. Postoperative pain may be due to anal stenosis caused by surgical sut...

Understanding Anal Fissures: Surgical Options and Management Tips

Hello, Doctor. I have been experiencing anal fissures (located at the six o'clock position, towards the back) for about 1 to 2 years, with episodes of healing and recurrence. Typically, I feel discomfort during bowel movements, as if the anus is being stretched, which feels ...

Dr. Ke Fangxu reply Surgery
1. No. 2. There is no need for sutures; postoperative pain during bowel movements is unavoidable but should be less severe than before the surgery. Wound care can be managed with sitz baths. 3. It is not necessary to remove them; they can heal on their own regardless of wheth...