The indications for repairing an anal sphincter are usually disruption following injury. The latter almost always relates to a traumatic vaginal delivery. On most occasions this is recognised at the time of the delivery and an immediate repair is undertaken by the attending obstetrician. However a secondary repair may be required if it is deemed that the primary repair has been suboptimal.
Pre-operative Preparation for a Anal Sphincter Repair procedure
You will be restricted to fluids only for the whole day prior to your procedure up to midnight. From midnight through to 2 hours prior to the procedure you can drink water only and from then on, until after the procedure you must be nil by mouth. You are also required to administer a Fleet enema at least 2 hours prior to your operation. You will receive specific instructions about this well in advance of the procedure, including an admission time and an approximate time for the procedure itself. You should take your normal medications as usual with a sip of water unless specifically directed otherwise. All anti-coagulant therapy should have been ceased in accordance with instructions issued by Dr Renaut’s office.
Procedure
The operation is performed under general anaesthesia. The patient is normally required to stay in hospital for three to four days or at least until the bowels are working satisfactorily. Most sphincter injuries are anterior, ie the segment of sphincter directly behind the vagina. The objective is to do an overlapping repair of the externals (voluntary) sphincter. A horseshoe incision is made around the anus. The ends of the separated external sphincter are located and brought to the midline. An overlapping repair is then fashioned. The wound is closed with usually absorbable sutures that go under the skin (and therefore do not need to be removed). A small plastic drain may be inserted that allows the drainage of excess fluid that might collect in the immediate post-operative period. This is usually taken out on the ward before discharge.
Post-operative Care following a Anal Sphincter Repair procedure
Following your procedure there are a number of things of which you need to be aware.
Discomfort
It is inevitable that you will experience some discomfort following your surgery in the region of where the anal sphincter repair has been performed. As it is a relatively small incision this discomfort should be no greater than the pain you were experiencing. Long acting local anaesthetic will have been injected into the wounds but after a few hours this effect will wear off. Before it does so it is important to have some pain killers on board and to continue these on a regular basis. You will be sent home with some pain killers - my preference is either Panadeine Forte or Nurofen. I recommend that you take these initially on a regular basis as directed on the packet. After about 48hrs it should be necessary to take these only as required.
Bowel activity
The bowels will probably not work for a couple of days after the surgery. Medication in the form of Coloxyl will be prescribed to keep the stool soft and this should be continued at home for several days. It is also advisable to add in a fibre supplement such as Metamucil or Normocol. A normal diet can be resumed straight away.
Bleeding
A small amount of bleeding in the first two or three days is not unexpected, particularly with defaecation. If it appears excessive then simply apply some pressure with a gauze pad for 15-20mins.
Swelling
You may experience swelling in the perianal region lasting for a few days but this will subside of its own accord in due course.
Wound Care
The healing of the anal sphincter repair wound can be aided by simply cleaning the wound with soap and water in the shower, particularly once again after defaecation. Bathing the area in a warm salt bath may help your level of discomfort but probably won't alter the way the area heals. Infection is unusual and if it does occur will usually settle of its own accord without the need for antibiotics. Any sutures will dissolve by themselves. If you think they have fallen out prematurely and the wound is gaping do not be alarmed - it will close by itself without the need for resuturing.
Physical Activity (including sexual activity)
Resuming physical activity is largely one of common sense. Certainly moving around the house and going for short walks in the first couple of days is desirable. Anything more than this will be destined to cause more discomfort. An increase in the level of activity should be guided by the level of discomfort. You should be able to resume your normal day to day activities within a few days, so long as this does not include marked exertion. You should however be able to return to the gym or similar activities within a couple of weeks.
Follow up
Dr Renaut will see you for a review in his office approximately four to six weeks after the surgery. He routinely notifies your GP of all procedures and your progress.