Anal Bulking

Anal bulking is a treatment option for patients with faecal incontinence caused by anal sphincter problems who have failed other treatment measures. These patients often have leakage of stool, which can occur on exercise, after having a bowel motion, or without any warning. Anal bulking improves anal function by providing bulk to muscle tissue or closing gaps in the anal muscles. There are a number of bulking products available; the ones I presently use in my practice are Gatekeeper™ (polyacrylonitrile) and Solesta® (hyaluronic acid/dextranomer). You will have the opportunity to discuss fully all the risks and benefits of the operation with me before signing your consent form.

Anal bulking is performed as an open procedure and involving placing 3–4 injections of the bulking product into the anal sphincter muscle (the exact position depends on the product used). The whole procedure takes approximately 15–30 minutes. You are given an injection of local anaesthetic before you leave the operating theatre to help keep you pain-free in the 6 hours after your surgery.

The procedure is done on a day-stay basis under general anaesthesia, so you will be asleep and feel no pain. You will need to fast from midnight on the night before if your surgery is scheduled for the morning, or from 7 am if it scheduled for the afternoon.

No special bowel preparation is necessary before your procedure, unless you are also having a colonoscopy in the same sitting. You will receive an enema one hour or so before your surgery.

After the procedure, you will be transferred to the recovery area and then to the ward. You should be able to go home the same day, but sometimes patients may need to stay longer. You should not drive after your procedure, so a friend or relative will need to take you home.

Discomfort is common after this procedure when your local anaesthetic wears off. This will get better, but may take up to 4 weeks to resolve completely. It is important to keep your bowel movements soft and regular during this time. To prevent constipation, eat foods high in fibre and drink plenty of water (6–8 glasses a day). Analgesia and laxatives will be given to you to take home. It is best to keep up with these until your bowels are moving and any discomfort is manageable.

You can expect minor bleeding after your surgery. A sanitary towel changed twice daily will help to prevent staining of underwear. Generally, use water to wash the anus twice a day and after every bowel movement.

These bulking agents cannot be felt and do not block the back passage, so you will be able to go to the toilet normally after the procedure. Patients are usually able to resume all normal activities the day after an anal bulking procedure, including going back to work. Some people do take longer to recover.

Exactly when patients can resume driving after this type of surgery is determined on a case-by-case basis. This is usually one week, but this will be discussed with you after your surgery. Please let your insurance company know when you have been given the all-clear to resume driving.

Some people notice an effect in 48 hours and improvements may be noticed for up to 3 months. Overall, 3 in 5 people who undergo anal bulking report that their incontinence had improved. One in 5 people may benefit from a second course of injections.

Patients generally have better control of their bowel movements, fewer leaks, and more days without accidents after this procedure. Injections do not prevent patients receiving other treatments in the future if bowel incontinence remains a problem.

A follow-up appointment in the clinic will be arranged in 1–2 weeks after your surgery to discuss further management if necessary.