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The anal sphincter muscle is made up of two muscles: the internal sphincter and the external sphincter muscle. These muscles are used to control bowel movements. Damage to one or both of these muscles can result in a decreased ability to control bowel movements and can lead to faecal incontinence. Faecal incontinence is the release of rectal contents against one's wishes. This can cause extreme embarrassment. However, there is hope for those suffering from faecal incontinence due to anal sphincter muscle damage. The muscles can be strengthened through exercises and behavioural techniques. Surgery is also an option for repairing and tightening the muscles.
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What You'll Learn
- Childbirth is a common cause of anal sphincter damage in women
- Exercises can help strengthen the sphincter muscles
- Surgery can repair and tighten torn sphincter muscles
- Botox injections can help relax the sphincter muscle
- Lateral internal sphincterotomy is a surgical procedure to treat chronic anal fissures
Childbirth is a common cause of anal sphincter damage in women
Anal sphincter damage is a common occurrence, causing faecal incontinence in 3-15% of the UK population. This condition is especially common in women following childbirth, with damage to the anal sphincter being the leading cause of faecal incontinence in women. This is known as obstetric anal sphincter injury (OASI or OASIS).
Childbirth is a physically demanding process, and the perineum, the area between the vagina and the anus, is put under a lot of pressure. This can result in tearing in the perineum, which can extend to the anal sphincter. In fact, one study found that 10% of women with a Grade-3a/3b tear had some degree of damage to their internal anal sphincter (IAS).
The risk of anal sphincter damage is heightened in vaginal deliveries, with damage occurring in 1-3% of cases. The severity of the tear is a critical factor, as it can determine the functional outcomes and the mode of delivery in future pregnancies. Accurate diagnosis of IAS trauma is important, as a significant proportion of injuries may be missed initially. Physician anxiety and a lack of diagnostic tools are possible contributing factors to the underdiagnosis of IAS trauma.
Women who have experienced obstetric anal sphincter injuries may face physical and psychological consequences. Physically, the injury can cause fecal incontinence, which can be extremely embarrassing and isolating. This can be treated through pelvic muscle retraining and exercises to strengthen the sphincter muscles. In more severe cases, surgery can be performed to repair and tighten the muscles.
Psychologically, women may experience anxiety, loneliness, shame, and fear associated with the physical ramifications of the injury. These feelings can impact their daily lives and future pregnancies. It is important for healthcare professionals to be educated about the sequelae of OASIS to provide appropriate information and support to affected women and their families.
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Exercises can help strengthen the sphincter muscles
The external anal sphincter is a thick, red, voluntary muscle that you can squeeze when you need to use the bathroom but are not near one. You have conscious control over the external anal sphincter, but not the internal one. Weak sphincter muscles can lead to faecal incontinence, which is when you release your rectal contents against your wishes. This can be caused by childbirth, increasing age, or surgery.
If you are suffering from faecal incontinence due to weak sphincter muscles, there are exercises you can do to strengthen them. These exercises can help you regain continence and improve your bowel control. To locate your sphincter muscles, pretend that you are trying to prevent a bowel movement. You should feel the muscles around your anus tighten.
There are several exercises you can do to strengthen these muscles. One is to squeeze the muscles for as long as you can while relaxing in between each squeeze. Try to hold for up to 10 seconds and repeat this up to 10 times. Then, squeeze as hard as you can and relax, repeating this up to 10 times as well. You can do these exercises in any position that is comfortable for you, such as sitting, standing, or lying down. It is recommended that you do each set of exercises 3 times a day.
If you are unsure if these exercises are suitable for you, consult a healthcare professional such as a continence physiotherapist or specialist continence nurse. They can guide you through the exercises and help you track your progress. If exercises do not help, surgery is an option to repair and tighten the muscles.
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Surgery can repair and tighten torn sphincter muscles
Surgery can be performed to repair and tighten torn sphincter muscles. This is recommended when other treatments, such as exercises, have not been effective. Childbirth is the most common cause of damage to the sphincter muscles in women, and surgery can be considered in such cases.
There are several surgical procedures that can be used to repair torn sphincter muscles. One such procedure is a lateral internal sphincterotomy, which involves making a small incision into the internal anal sphincter muscle to release excess tension that may be preventing a wound from healing. This procedure is typically recommended for chronic anal fissures that have failed to heal.
Another procedure is a fissurectomy, which is a newer alternative to a lateral internal sphincterotomy. This procedure does not involve cutting the sphincter muscle but instead removes the surface layer of the wound, including any scar tissue, to help the wound heal. A Botox injection into the sphincter muscle may also be administered to help it relax and aid in the healing process.
Anal sphincteroplasty is another surgical procedure used to repair torn or weakened anal sphincter muscles. This procedure is commonly used to treat faecal incontinence caused by anal muscle damage during childbirth. It involves repairing the defect in the circle of muscle that controls bowel movements.
In cases of severe faecal incontinence, an artificial sphincter may be implanted. This involves placing an inflatable sphincter around the anus, which can be deflated using a pump to allow faecal matter to pass through. Bulking agents can also be injected into the wall of the anus to bulk up the tissue, making the opening narrower so that the sphincters can close better.
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Botox injections can help relax the sphincter muscle
The anal sphincter muscles can become weak due to various reasons, such as childbirth, increasing age, constipation, or faecal incontinence. This can lead to individuals experiencing difficulty controlling their bowel movements and gas, resulting in leakage and extreme embarrassment. While there are exercises and behavioural techniques to strengthen these muscles, Botox injections offer an alternative solution.
Botox injections, formally known as botulinum toxin type A injections, can be used to help relax the sphincter muscle. This treatment is commonly used in the urinary sphincter muscle to address issues with urination. When injected, Botox blocks nerve signals from the brain to the bladder muscles, allowing the sphincter muscles to relax. This relaxation enables urine to pass out of the bladder more easily and facilitates catheter insertion. The effects of the injections are typically noticed within a few weeks, with the highest effectiveness observed a month after the procedure.
In the context of the anal sphincter muscle, Botox injections can be considered for individuals experiencing faecal incontinence due to muscle weakness. By blocking nerve signals to the muscles, Botox helps prevent the muscles from contracting or tensing up. This relaxation can improve the ability to control bowel movements and reduce leakage. It is important to note that the effects of Botox injections are temporary, typically lasting a few months, and retreatment may be recommended after this period.
While Botox injections can provide relief by relaxing the sphincter muscle, it is crucial to consult a healthcare professional to determine the most suitable treatment option. They will assess the individual's unique needs and consider other factors, such as potential side effects and safety precautions, before recommending Botox injections or alternative treatments like exercises, behavioural techniques, or surgical procedures.
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Lateral internal sphincterotomy is a surgical procedure to treat chronic anal fissures
Anal fissures are a common condition that causes a lot of pain, especially during bowel movements. While most anal fissures heal easily, some may resist healing and become chronic. This happens when excess tension in the internal sphincter muscle prevents them from healing. In such cases, surgery is often the best option for a cure.
Lateral internal sphincterotomy is an outpatient procedure, meaning patients can go home the same day. However, they will need to arrange for someone else to drive them due to the effects of the anaesthesia. While the procedure has a high success rate, there is a small risk of short-term and long-term complications, such as bleeding, infection, and minor faecal incontinence.
Before considering surgery, healthcare providers typically recommend non-surgical treatments for anal fissures. This can include ointments, creams, or Botox injections to help relax the sphincter muscle. Maintaining a high-fibre diet, increasing fluid intake, and exercising regularly can also help prevent and treat constipation, which is a common cause of anal fissures. If these conservative treatments are unsuccessful, surgery may be recommended.
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Frequently asked questions
A sphincter injury refers to a tear or damage to the muscle that surrounds the anal canal. The anal sphincter muscle consists of two muscles; the internal sphincter and the external sphincter muscle. These muscles are used to control bowel movements.
Childbirth is the most common cause of damage in women. Other causes include anal or rectal surgery, obstetrical trauma, or other trauma to the rectum.
Most anal fissures will heal on their own and can be helped along with self-care. This includes using a stool softener, a step stool to support your feet while sitting on the toilet, and prescription creams for pain relief. If your fissure hasn't healed after several weeks, you may need medication or surgery.
Yes, your muscles may be weakened, but this can often be treated through numerous exercises and behavioural techniques. Even individuals with structural damage can regain continence through behavioural treatment.
