Sphincter Repair (Sphincteroplasty)

Overview

The external anal sphincter is the muscle you squeeze voluntarily when you need to hold on. When it tears — most often during a difficult childbirth — the ends can separate, leaving a gap that makes it very hard to control your bowel. Sphincteroplasty (also called an overlap repair) fixes this gap: Mr Nguyen makes a small incision in the perineum (the area between the back passage and the genitals), finds the two ends of the torn muscle, brings them together, and stitches them back in an overlapping fashion using strong sutures. Think of it like rejoining two ends of a rubber band so the ring is restored.

In experienced hands, around 50–70% of patients achieve meaningful improvement in continence. It works best for tears at the front of the sphincter — the most common type after childbirth.

Who needs this procedure?

• You have faecal incontinence (difficulty controlling your bowels) caused by a gap or tear in the sphincter muscle — most often after a third or fourth degree tear during childbirth
• Your sphincter was damaged during a previous operation around the back passage
• You have had a traumatic injury to the sphincter
• Diet changes, medications, and physiotherapy have not given you enough improvement
• An endoanal ultrasound (an internal scan of the sphincter) or MRI has confirmed the gap in the muscle
• You prefer a surgical repair over an implanted device, or sacral neuromodulation is not suitable for you

Benefits

• Repairs the actual physical gap in your muscle — addressing the root cause of the problem
• Works particularly well for tears at the front of the sphincter, which is where most childbirth injuries occur
• No implanted device to maintain, charge, or replace
• Well-established procedure with proven long-term results when performed by a specialist colorectal surgeon
• If the perineal body (the tissue between the back passage and vagina) has also thinned, this can be rebuilt at the same time
• Many patients feel significantly more confident in social situations and daily life

Risks & considerations

• Wound infection or wound breakdown — occurs in 10–20% of patients; the perineal area is difficult to keep completely dry and is close to the bowel, which increases this risk. Most infections are managed with antibiotics and wound care at home and heal well, just more slowly.
• Repair not holding as well over time — around 30–50% of patients notice some return of symptoms by 5 years. This does not mean the operation has failed; many still have meaningful improvement, and other treatments remain available
• Fistula (an abnormal channel) — rare
• Pain with sex (dyspareunia) — may improve or, in some cases, may be temporarily affected by the repair; this is discussed in detail before your operation
• Swelling or bleeding around the repair site — usually settles within a few days
• Perineal wounds heal more slowly than most surgical wounds — allow 4–8 weeks for full healing

Before the procedure

• You will have an endoanal ultrasound (an internal scan of the sphincter muscles) and anorectal manometry (a short pressure test) beforehand — both are done in the rooms without sedation and give Mr Nguyen the information needed to plan your surgery
• You will be asked to do a bowel preparation (a laxative drink) the day before surgery to clear the bowel — this reduces infection risk
• Anti-inflammatory medications (NSAIDs like ibuprofen) are stopped in the days before surgery as directed
• You will be prescribed antibiotics to take around the time of the operation
• Mr Nguyen will talk through all the risks and realistic expectations with you before you sign consent — there are no silly questions

On the day

• You will have either a general anaesthetic (you are fully asleep) or a spinal anaesthetic (you are awake but completely numb from the waist down) — Mr Nguyen and the anaesthetist will recommend what suits you best
• You will be positioned face down or on your back with your knees up, whichever gives the best access
• A small incision is made in the perineum; the two ends of the torn sphincter muscle are carefully identified, freed up, and overlapped using strong stitches
• If the perineal body has thinned, it is rebuilt at the same time
• The wound is closed in layers; a small drain may be placed for the first day or two if needed
• You will wake up in the recovery room with a urinary catheter (a thin tube to drain your bladder) which usually stays in for 24–48 hours while the area is healing

Recovery & aftercare

• Days 1–2: The nursing team will help you start moving around. You will start on fluids and progress to soft foods.
• Days 3–5: Most patients go home with oral pain relief tablets and a stool softener to keep your bowel motions soft and easy — straining at this stage is to be avoided
• Weeks 1–4: Take it easy. Short walks are fine and encouraged. Avoid lifting anything heavier than a bag of groceries.
• Weeks 6–8: Most people are back to their usual activities by this point
• Pelvic floor physiotherapy after surgery is strongly recommended — it helps the repair work as well as possible and is one of the most important things you can do for your recovery
• Mr Nguyen will keep a close eye on your wound healing and continence at follow-up appointments
• A post-operative review with Mr Nguyen is routinely arranged 2–6 weeks following your procedure, with timing depending on the type of operation — this review is provided at no charge

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