Surgical Management of Fecal Incontinence and Implications for Postoperative Nursing Care

  • Sarah Abbott
  • Ronan O’Connell


Surgical management of fecal incontinence is only considered following comprehensive multidisciplinary assessment and failure of conservative measures to achieve a quality of life acceptable to the client. It is important at the outset to realize that surgical intervention, except in the situation of surgical repair of an acute anal sphincter injury, can rarely restore perfect continence. Realistic expectation of outcomes is essential and requires careful explanation of the underlying causes which are often multifactorial. This chapter explains the common surgical procedures used for treating problems underlying fecal incontinence and the focused postoperative nursing care for the advanced practice continence nurse. Having a general knowledge of the repairs of the surgical procedures and of the indications for and expected outcomes of the surgeries may assist the advanced practice continence nurse in decision-making for patient referrals, postoperative management, and support of the patient. The chapter also discusses innovative and experimental procedures for fecal incontinence currently being investigated.


Surgery Postoperative care Sphincteroplasty Neuromodulation Stoma 


  1. 1.
    Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C. Obstetric events leading to anal sphincter damage. Obstet Gynecol. 1998;92(6):955–61.PubMedGoogle Scholar
  2. 2.
    Royal College of Obstetricians and Gynaecologists. The management of third and fourth degree perineal tears 2015.
  3. 3.
    Fernando R, Sultan AH, Kettle C, Thakar R, Radley S. Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev. 2006.
  4. 4.
    American College of Obstetricians and Gynecologists Committee on Practice Bulletins. Practice Bulletin No. 165: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2016;128(1):e1–e15.CrossRefGoogle Scholar
  5. 5.
    Mahony R, Behan M, O’Herlihy C, O’Connell PR. Randomized, clinical trial of bowel confinement vs. laxative use after primary repair of a third-degree obstetric anal sphincter tear. Dis Colon Rectum. 2004;47(1):12–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Eogan M, Daly L, Behan M, O’Connell PR, O’Herlihy C. Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury. BJOG. 2007;114(6):736–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Fitzpatrick M, Cassidy M, O’Connell PR, O’Herlihy C. Experience with an obstetric perineal clinic. Eur J Obstet Gynecol Reprod Biol. 2002;100(2):199–203.CrossRefPubMedGoogle Scholar
  8. 8.
    Fynes M, Donnelly V, Behan M, O’Connell PR, O’Herlihy C. Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet. 1999;354(9183):983–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004;47(5):727–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Chapman AE, Geerdes B, Hewett P, Young J, Eyers T, Kiroff G, et al. Systematic review of dynamic graciloplasty in the treatment of faecal incontinence. Br J Surg. 2002;89(2):138–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet. 1995;346(8983):1124–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Carrington EV, Evers J, Grossi U, Dinning PG, Scott SM, O’Connell PR, et al. A systematic review of sacral nerve stimulation mechanisms in the treatment of fecal incontinence and constipation. Neurogastroenterol Motil. 2014;26(9):1222–37.CrossRefPubMedGoogle Scholar
  13. 13.
    Maeda Y, Norton C, Lundby L, Buntzen S, Laurberg S. Predictors of the outcome of percutaneous nerve evaluation for faecal incontinence. Br J Surg. 2010;97(7):1096–102.CrossRefPubMedGoogle Scholar
  14. 14.
    Tan E, Ngo N-T, Darzi A, Shenouda M, Tekkis PP. Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int J Colorectal Dis. 2011;26(3):275–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Thaha MA, Abukar AA, Thin NN, Ramsanahie A, Knowles CH. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev. 2015.
  16. 16.
    Ratto C, Litta F, Parello A, Donisi L, De Simone V, Zaccone G. Sacral nerve stimulation in faecal incontinence associated with an anal sphincter lesion: a systematic review. Colorectal Dis. 2012;14(6):e297–304.CrossRefPubMedGoogle Scholar
  17. 17.
    Mellgren A, Wexner SD, Coller JA, Devroede G, Lerew DR, Madoff RD, et al. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum. 2011;54(9):1065–75.CrossRefPubMedGoogle Scholar
  18. 18.
    Shafik A, Ahmed I, El-Sibai O, Mostafa RM. Percutaneous peripheral neuromodulation in the treatment of fecal incontinence. Eur Surg Res. 2003;35(2):103–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Thin NN, Taylor SJ, Bremner SA, Emmanuel AV, Hounsome N, Williams NS, et al. Randomized clinical trial of sacral versus percutaneous tibial nerve stimulation in patients with faecal incontinence. Br J Surg. 2015;102(4):349–58.CrossRefPubMedGoogle Scholar
  20. 20.
    Horrocks EJ, Bremner SA, Stevens N, Norton C, Gilbert D, O’Connell PR, et al. Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial). Health Technol Assess. 2015;19(77):1–164.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    van der Wilt AA, Giuliani G, Kubis C, van Wunnik BPW, Ferreira I, Breukink SO, et al. Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence. Br J Surg. 2017;104(9):1167–76.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Consten ECJ, van Iersel JJ, Verheijen PM, Broeders IAMJ, Wolthuis AM, D’Hoore A. Long-term outcome after laparoscopic ventral mesh rectopexy: an observational study of 919 consecutive patients. Ann Surg. 2015;262(5):742–7.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015;58(7):623–36.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141–57.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Colquhoun P, Kaiser R Jr, Efron J, Weiss EG, Nogueras JJ, Vernava AM 3rd, et al. Is the quality of life better in patients with colostomy than patients with fecal incontience? World J Surg. 2006;30(10):1925–8.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Norton C, Burch J, Kamm MA. Patients’ views of a colostomy for fecal incontinence. Dis Colon Rectum. 2005;48(5):1062–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Sugrue J, Lehur P, Madoff RD, McNevin S, Buntzen S, Laurberg S, Mellgren A. Long-term experience of magnetic anal sphincter augmentation in patients with fecal incontinence. Dis Colon Rectum. 2017;60(1):87–95.CrossRefPubMedGoogle Scholar
  28. 28.
    Ratto C, Buntzen S, Aigner F, Altomare DF, Heydari A, Donisi L, et al. Multicentre observational study of the Gatekeeper for faecal incontinence. Br J Surg. 2016;103(3):290–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Ratto C, Donisi L, Litta F, Campennì P, Parello A. Implantation of SphinKeeper(TM): a new artificial anal sphincter. Tech Coloproctol. 2016;20(1):59–66.CrossRefPubMedGoogle Scholar
  30. 30.
    Takahashi T, Garcia-Osogobio S, Valdovinos MA, Belmonte C, Barreto C, Velasco L. Extended two-year results of radio-frequency energy delivery for the treatment of fecal incontinence (the Secca procedure). Dis Colon Rectum. 2003;46(6):711–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Surgery and Surgical SpecialtiesUniversity College DublinBelfield, Dublin 4Ireland
  2. 2.St. Vincent’s University HospitalDublin 4Ireland

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