Anal Sphincter: A Comprehensive Review

Negar Abbasi Aval, Saeid Aslanabadi, Mahshid Kharaziha, Sina Zarrintan, Farzad Ilkhchooyi



Anal incontinence is of potential clinical interest and significance. Comprehensive knowledge of anal clinical anatomy and function is essential to understand pathophysiological processes that lead to sphincter malfunction. We review anatomy, physiology and surgical pathology of anal sphincter. We also discuss surgical procedures which may be used for patients with fecal incontinence.



anus; sphincter; incontinence

Full Text:




Bartlett L, Nowak M, Ho Y-H. Impact of fecal incontinence on quality of life. World journal of gastroenterology: WJG. 2009;15(26):3276.

Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. US householder survey of functional gastrointestinal disorders. Digestive diseases and sciences. 1993;38(9):1569-80.

Novi JM. Fecal Incontinence in Women. Perimenopause. 2008:169.

MacArthur C, Bick DE, Keighley MR. Faecal incontinence after childbirth. BJOG: An International Journal of Obstetrics & Gynaecology. 1997;104(1):46-50.

Read NW, Harford WV, Schmulen AC, Read MG, Santa Ana C, Fordtran JS. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology. 1979;76(4):747-56.

Vitton V, Damon H, Roman S, Nancey S, Flourié B, Mion F. Transcutaneous posterior tibial nerve stimulation for fecal incontinence in inflammatory bowel disease patients: a therapeutic option? Inflammatory bowel diseases. 2009;15(3):402-5.

Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004;126:S14-S22.

Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO. Radiation dose–volume effects in radiation-induced rectal injury. International Journal of Radiation Oncology* Biology* Physics. 2010;76(3):S123-S9.

Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence. Diseases of the colon & rectum. 1999;42(12):1525-31.

Allgayer H, Dietrich CF, Rohde W, Koch GF, Tuschhoff T. Prospective comparison of short-and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scandinavian journal of gastroenterology. 2005;40(10):1168-75.

Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Diseases of the colon & rectum. 1993;36(1):77-97.

Rao SS. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clinical Gastroenterology and Hepatology. 2010;8(11):910-9. e2.

Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch K, Fürst A. Dynamic magnetic resonance imaging defecography. Diseases of the colon & rectum. 2001;44(7):999-1007.

Morgan CN. The surgical anatomy of the anal canal and rectum. Postgraduate medical journal. 1936;12(130):287.

Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003;125(5):1320-9.

Wald A. Fecal incontinence in adults. New England Journal of Medicine. 2007;356(16):1648-55.

Harford WV, Krejs GJ, Santa Ana CA, Fordtran JS. Acute effect of diphenoxylate with atropine (Lomotil) in patients with chronic diarrhea and fecal incontinence. Gastroenterology. 1980;78(3):440-3.

Tsou V, Bishop P, Nowicki MJ. Colonic sunflower seed bezoar. Pediatrics. 1997;99(6):896-7.

Zorcolo L, Bartolo D. Surgical Treatment of Fecal Incontinence. Benign Anorectal Diseases: Springer; 2006. p. 327-42.

Pescatori LC, Pescatori M. Sphincteroplasty for anal incontinence. Gastroenterology report. 2014;2(2):92-7.

Goetz LH, Lowry AC. Overlapping sphincteroplasty: is it the standard of care? Clinics in colon and rectal surgery. 2005;18(1):22.

Abbas SM, Bissett IP. Postanal pelvic floor repair. Fecal Incontinence: Springer; 2007. p. 179-83.

Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clinics in colon and rectal surgery. 2005;18(1):46.

Labow S, Rubin RJ, Hoexter B, Salvati EP. Perineal repair of rectal procidentia with an elastic fabric sling. Diseases of the Colon & Rectum. 1980;23(7):467-9.

Lomas MI, Cooperman H. Correction of rectal procidentia by use of polypropylene mesh (Marlex). Diseases of the Colon & Rectum. 1972;15(6):416-9.

Zutshi M, Hull T, Gurland B. Anal encirclement with sphincter repair (AESR procedure) using a biological graft for anal sphincter damage involving the entire circumference. Colorectal Disease. 2012;14(5):592-5.

Sainio AP, Halme LE, Husa AI. Anal encirclement with polypropylene mesh for rectal prolapse and incontinence. Diseases of the colon & rectum. 1991;34(10):905-8.

Margolin DA. New options for the treatment of fecal incontinence. 2009.

Zbar AP. Sacral neuromodulation and peripheral nerve stimulation in patients with anal incontinence: an overview of techniques, complications and troubleshooting. Gastroenterology report. 2014;2(2):112-20.

Gregorcyk SG. The Current Status of the Acticon® Neosphincter. Clinics in colon and rectal surgery. 2005;18(1):32.

Wong WD, Congliosi SM, Spencer MP, Corman ML, Tan P, Opelka FG, et al. The safety and efficacy of the artificial bowel sphincter for fecal incontinence. Diseases of the colon & rectum. 2002;45(9):1139-53.

Doll A, Heinrichs M, Goldschmidtboeing F, Schrag H-J, Hopt U, Woias P. A high performance bidirectional micropump for a novel artificial sphincter system. Sensors and Actuators A: Physical. 2006;130:445-53.

Lehur P-A, McNevin S, Buntzen S, Mellgren AF, Laurberg S, Madoff RD. Magnetic anal sphincter augmentation for the treatment of fecal incontinence: a preliminary report from a feasibility study. Diseases of the Colon & Rectum. 2010;53(12):1604-10.

Pakravan F, Helmes C. Magnetic anal sphincter augmentation in patients with severe fecal incontinence. Diseases of the Colon & Rectum. 2015;58(1):109-14.

Tevlin R, Hanly A, Larkin J, O’Connell R. PTH-021 Magnetic Anal Sphincter–a Novel Surgical Option for Management of Faecal Incontinence. Gut. 2013;62(Suppl 1):A219-A20.

Franks I. Fecal incontinence: Magnetic anal sphincter augmentation shows promising outcomes in patients with fecal incontinence. Nature Reviews Gastroenterology and Hepatology. 2011;8(2):66-.

Walker CA, Rau LA, Green MP. Welcoming Home the Patient with a New Ostomy. Home healthcare now. 2015;33(7):385-9.

Efron JE, Corman ML, Fleshman J, Barnett J, Nagle D, Birnbaum E, et al. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca® procedure) for the treatment of fecal incontinence. Diseases of the colon & rectum. 2003;46(12):1606-16.

Takahashi T, Garcia-Osogobio S, Valdovinos MA, Belmonte C, Barreto C, Velasco L. Extended two-year results of radio-frequency energy delivery for the treatment of fecal incontinence (the Secca procedure). Diseases of the colon & rectum. 2003;46(6):711-5.

Mortensen N, Humphreys MS. The anal continence plug: a disposable device for patients with anorectal incontinence. The Lancet. 1991;338(8762):295-7.

Norton C, Kamm M. Anal plug for faecal incontinence. Colorectal Disease. 2001;3(5):323-7.

Tuteja A, Rao S. Recent trends in diagnosis and treatment of faecal incontinence. Alimentary pharmacology & therapeutics. 2004;19(8):829-40.

Van Winckel M, Van Biervliet S, Van Laecke E, Hoebeke P. Is an anal plug useful in the treatment of fecal incontinence in children with spina bifida or anal atresia? The Journal of urology. 2006;176(1):342-4.

Pfrommer W, Holschneider A, Löffler N, Schauff B, Ure B. A new polyurethane anal plug in the treatment of incontinence after anal atresia repair. European journal of pediatric surgery: official journal of Austrian Association of Pediatric Surgery[et al]= Zeitschrift fur Kinderchirurgie. 2000;10(3):186-90.

Christiansen J, Roed-Petersen K. Clinical assessment of the anal continence plug. Diseases of the colon & rectum. 1993;36(8):740-2.

Chew MH, Quah HM, Ooi BS, Lim JF, Ho KS, Tang CL, et al. A prospective study assessing anal plug for containment of faecal soilage and incontinence. Colorectal Disease. 2008;10(7):677-80.

Cazemier M, Felt-Bersma R, Mulder C. Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation. World journal of gastroenterology: WJG. 2007;13(22):3101-5.

Giamundo P, Welber A, Weiss EG, Vernava AM, Nogueras JJ, Wexner SD. The procon incontinence device: a new nonsurgical approach to preventing episodes of fecal incontinence. The American journal of gastroenterology. 2002;97(9):2328-32.



  • There are currently no refbacks.