Anal incontinence

Anal incontinence is a life restricting condition that is sometimes challenging to treat. There is an equal gender prevalence, however women are more likely to present particularly early in life, as a result of obstetric injury. This is still one of the leading causes of anal incontinence and sphincter tears can be missed at the time of delivery. As a result, there is a heightened awareness for sphincter injury based on risk assessment, digital rectal examination and an endo-anal ultrasound. Surgical repair is still invaluable in the presence of disruption and salvage procedures for severe refractory incontinence such as the dynamic gracilloplasty and the artificial bowel sphincter continue to be perfected. Mini invasive procedures such as rectal irrigation and sacral neuromodulaton have had a successful outcome and we have had to depend less on the more invasive treatments. Above all there is a growing need to protect not only the baby but also the pelvic floor and anal sphincter from traumatic deliveries, through early risk assessment and research.