Faecal incontinence in patients with anal fissure: a consequence of internal sphincterotomy or a feature of the condition?

Background And Objective: The function of the internal sphincter is disturbed in patients with chronic anal fissure due to persistent hypertonia and it may lead to a certain degree of incontinence. Our aim is to assess the results of lateral internal sphincterotomy and to identify any degree of incontinence related to the disease.

Methods: This prospective study included a review of all patients operated upon by the authors who performed division of the internal sphincter at or below the upper limit of the fissure. A questionnaire was completed by each patient before surgery and then after surgery with regard to any degree of incontinence such as soiling of underclothes, control of flatus and accidental bowel motion.

Results: 126 patients with chronic anal fissure were studied. The male to female ratio was 0.8:1. Minor degrees of incontinence were present prior to surgery in 35 patients (28%) and in 31 (25%) patients after surgery, the majority of them were incontinent before surgery.

Conclusion: Based on the results of this study, minor degrees of incontinence could be a symptom of chronic anal fissure and not the sequelae of lateral internal sphincterotomy.