The effectiveness of surgical correction of traumatic anal incontinence in the presence of a functional neurogenic component

AIM: to assess the functional state of the anorectal sphincter apparatus and pudendal nerve conduction in patients with postpartum traumatic anal sphincter insufficiency, as well as to analyze clinical and functional outcomes of surgical correction in the presence of a functional neurogenic component.

PATIENTS AND METHODS: this pilot study included 39 female patients with postpartum anal sphincter insufficiency, with a mean age of 35.0 ± 6.6 years. Preoperative evaluation comprised clinical examination, transrectal ultrasound, anorectal manometry (comprehensive sphincterometry), and stimulation electromyography of the pudendal nerve with assessment of pudendal nerve terminal motor latency (PNTML). Severity of anal incontinence was evaluated using the Wexner score, pain intensity was assessed by the visual analog scale, and evacuation disorders were assessed using the GNCK scoring system. All patients underwent surgical correction using overlapping sphincteroplasty. Postoperative follow-up with repeated clinical and functional assessment was performed in 35 patients.

RESULTS: before surgery, all patients demonstrated decreased resting and squeeze pressures of the anal sphincter according to anorectal manometry. Impaired pudendal nerve conduction was detected in 71.8% of patients, indicating the presence of a functional neurogenic component of anal incontinence. After surgical correction, most patients showed a reduction in the severity of anal incontinence symptoms as assessed by the Wexner score, along with restoration of manometric parameters to physiological ranges. However, signs of pudendal neuropathy persisted predominantly in patients with a mixed mechanism of anal incontinence.

CONCLUSION: the presence of a functional neurogenic component in postpartum traumatic anal sphincter insufficiency influences clinical outcomes of surgical treatment. Comprehensive functional evaluation, including anorectal manometry and pudendal nerve electromyography, is essential for predicting treatment effectiveness and for planning a combined therapeutic approach incorporating both surgical and conservative modalities.

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