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 the anal sphincter. We also discuss surgical procedures which are used in cases of 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 2009;15(26):3276.

Drossman DA, Li Z, Andruzzi E, 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, et al: A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 1979;76(4):747-56.

Vitton V, Damon H, Roman S, et al: 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, et al: 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, 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, et al: 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, et al: 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, et al: 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, et al: 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;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;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, et al: 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, 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, et al: 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, et al: 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, et al: 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, 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, et al: 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, et al:. 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, et al: 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, 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 2007;13(22):3101-5.

Giamundo P, Welber A, Weiss EG, et al: 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.

pISSN: 2423-5067

eISSN: 2423-7612

Creative Commons License
This journal and its contents are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.