Surgical Management of Anal Incontinence

In most cases, conservative therapy should be the first line treatment for those with anal incontinence. In very selected patients, such as women in the post-partum period who have suffered an obstetric anal sphincter injury (OASI) and have a wound infection or breakdown, anal sphincter repair may be offered. There is evidence that the effectiveness of this operation will wane over time. Artifical anal sphincter devices are no longer routinely offered. Sacral neuromodulation is the most effective treatment available for those who do not improve with conservative measures and remains effective in the long term. However, its exact mechanism of action remains elusive. New anal injectable devices and regenerative medicine therapies may offer some promise. For those who fail all other therapies, a stoma may be the last resort of use.