Will conventional perianal surgery cause anal incontinence? I believe that most friends who suffer from perianal diseases are concerned about this issue. If we want to answer this question correctly, I think we should start with the anatomy of the human body. Generally speaking, everyone has internal and external sphincter muscles at the end of the rectal and anal canal. They have a sphincter function to the anus. The internal and external sphincter can move up and down slightly like a cannula. In addition, there is a deep part of the external sphincter called The "puborectalis" muscles, professionally, we call the internal sphincter, the deep and superficial external sphincter, the puborectalis, and the joint longitudinal muscle closely connected to the internal and external sphincter as the "anorectal ring". "The anorectal tube is very important to the human anal sphincter function. If the anorectal ring is not completely cut off, it will not cause anal incontinence.
So, let’s see if common perianal surgery can cause anal incontinence?
First, let's analyze whether hemorrhoid surgery causes anal incontinence. The main pathological changes of hemorrhoids are bleeding caused by vasodilation or prolapse caused by rupture of submucosal tendons. Whether we use injection, internal hemorrhoid ligation, laser, mixed hemorrhoid external peeling and internal ligation, etc., the scope of surgery is limited to subcutaneous or mucosal It will not damage the sphincter at all. If hemorrhoids affect the anus after hemorrhoid surgery, at best, too much ligation will cause anal stenosis, but it will not cause anal incontinence.
Secondly, if the anal fissure surgery uses an in situ fissure resection plus anal expansion (minimally invasive method), only the fibrous annulus inside the internal sphincter will be destroyed, and the external sphincter will not be damaged; if traditional anal fissure resection is used, the internal sphincter will be broken Surgery or anal fissure threading will not damage the external sphincter, and will not cut off the anorectal ring, so there is no risk of incontinence.
Finally, for anal fistulas, if the fistula runs between the subcutaneous and superficial parts of the external sphincter, the muscle that the doctor cuts is only the subcutaneous part of the external sphincter, which will not affect anal function; if the fistula runs between the superficial and deep parts , The cut muscles are only the subcutaneous and superficial parts of the external sphincter, and will not cause incontinence; if the fistula runs above the deep or even higher part of the external sphincter, you can cut off the sphincter below the internal mouth and hang the fistula above the internal mouth. For the problem of incontinence, chronic strangulation of the "rubber band" can well prevent anal incontinence caused by the sudden disconnection of the sphincter. Of course, if an experienced doctor can also open the sphincter below the inner orifice, expand the fistula above the inner orifice, and drain the anal fistula by placing a latex tube (also known as "non-thread therapy"). It should be noted that if only the superficial part or below the external sphincter is cut, even if multiple fistulas are opened at the same time, it will not cause anal incontinence.
In short, no matter what kind of anorectal surgery, as long as the "anorectal tube" is not cut once, the anus should not be incontinent.