Fecal Incontinence may manifest itself in the partial or complete forms, the result of disease in the lower rectum, or the destruction of the contractile power of the sphincter muscles from surgical operations. Operations for fistula most frequently cause incontinence. Incontinence is most likely to occur when the internal sphincter is cut and when both muscles have been cut in several places obliquely. The condition also follows operations for cancer, hemorrhoids, stricture, fissure, ulceration, and prolapse when parts of the muscles are incised, removed, or that an extremely large scar has formed as the result of slow granulation

Incontinence also occurs as the result of too rapid or extreme revulsion of the sphincters, injury or disease of the spinal cord, laceration of the sphincter during labor, and from providential, ulceration and stricture of the rectum.

Symptoms. The manifestation of fecal incontinence is the escape of gas and fecal matter which may be partially or completely beyond the control of the sufferer. The condition may be dependent upon the liquid, solid, or gaseous discharge. Patients who are constipated happily do not suffer so greatly as those with liquid movements. Temporary incontinence may supervene the incision for superficial fistula and relief come when the tract is healthily healed.

The non-operative treatment simply confines us to an effort to render the stool firm or of a semi-solid consistence to prevent frequent discharges. The diet should be regulated to foods which constipate. Opiates and astringent medicines may be administered when absolutely necessary, but opiates with care and judgment as to liability to habit formation.

The Surgical Treatments suggested for the relief or cure of incontinence are cauterization and plastic operation.

Cauterization is employed in the majority of cases and is attended with good results. The Jacqueline cattery is heated to a dull red and pressed into the mucous membrane and the sphincter muscles above, and brought out at the much-cutey-nous junction. The procedure should be repeated in a manner similar to the linear cauterization for prolapse-of the rectum at several points. The after-treatment is the same as in that operation, efforts being made to prevent adhesion by Vaseline-smeared strips of gauze, which are to be kept in the rectum for a week after operation. The operation to attain permanent success may be necessarily repeated at intervals of several months. Some surgeons simply cauterize at the point of separation of the sphincters with the idea of forming a firm, hard scar. The operative treatment often involves the repair of the vaginal wall in woman and therefore necessitate any of the common operations for a lacerated perineum or relaxed vaginal outlet. The operative procedure recommended in such cases is as follows: The vaginal and lower portion of the rectum is thoroughly cleansed and a V-shaped area is denuded which represents the torn wall of the rectum. The apex of the V should be up in the rectum between the torn fibers of the internal sphincter, and the two arms of the V rest upon the torn ends of the divided external sphincter muscles. The denuded surface should be slightly wider at these two points of the divided ends of the external sphincter. The torn ends of both sphincters should be dissected out and identified before attempting to bring the parts together. Sutures of silk or chronic gut are introduced in the manner represented in Fig. 90. with the ends in the rectum where they should be tied. The ends of the sutures are left long, protruding from the rectum. Repair of the vagina when necessary should be made secondary to this operation.

Fig 90. Repair of sphincters. Sutures in torn rectum, which protrude from the anus when completed.

Ger sing’s twisting of the rectum and Heartwood’s utilization of a portion of the gluten muscles for a sphincter are not generally performed for the relief of incontinence on account of the scsrcity of statistics supporting their value.

Left inguinal colostomy is advocated by some surgeons when local operations have proved futile and when the case is complicated by the severe annoyance of chronic diarrhea.