Understanding Sphincter Size Changes Post-Surgery : A Comprehensive Guide

The ring-like muscles that act as valves to control the flow of substances in our body are known as sphincters. These muscles maintain constrictions of a passage in the body. The human body comprises numerous sphincters, including those that control the release of feces and urine. So some of the main sphincters are anal sphincters, urethral sphincters, esophageal sphincters, and others. Surgical and other medical interventions can impact the size of sphincters and these effects on sphincter size depend primarily on the specific surgical or medical intervention taking place and also individual factors like age, health condition, and overall anatomy of a patient.

In the following sections of this article, we will take a look at the effects of surgery and medical intervention on sphincter size and also learn how these changes in the size of sphincters affect the overall quality of life in the patients.

About 25% of the Western population is affected by Gastroesophageal reflux disease (GERD) and the prevalence is constantly increasing.⁽¹⁾ Surgery for GERD involves a procedure that reinforces the lower esophageal sphincter. This procedure is called Nissen fundoplication.

In this surgical procedure, the surgeon wraps the top of the stomach around the lower esophagus, which in turn tightens the lower esophageal sphincter, thus making it less likely that acid will back up in the esophagus. There are two types of Nissen fundoplication, which include Laparoscopic procedures (tiny incisions or cuts are made) and Open procedures (larger incisions are made).

Thus, procedures like Nissen fundoplication can significantly impact the size and function of the lower esophageal sphincter.

Magnetic sphincter augmentation (MSA) is another surgical approach that treats gastroesophageal reflux diseases (GERD). It has become an increasingly common surgical procedure for patients with GERD. The US Food and Drug Administration, in 2012, approved the use of MSA as a surgical intervention for patients with GERD.⁽²⁾

The LINX Reflux Management System is a unique device that is used to perform Magnetic sphincter augmentation to treat gastroesophageal reflux disease by augmenting the native lower esophageal sphincter (LES) with the help of magnets.

Thus, magnetic sphincter augmentation (MSA) is another surgical procedure that tightens the openings of the lower esophageal sphincter and stops reflux.

Anal fistulas can be treated with specific surgical procedures, and there are different types of surgery to treat the conditions. All these surgical procedures aim to heal the fistula and avoid damaging the sphincter muscles, which are the ring of muscles that open and close the anus. Bowel incontinence or loss of bowel control can be experienced with damaged anal sphincter muscles.

Some surgeries that impact the size of anal sphincters are:

This is a surgery used to remove external or internal hemorrhoids (enlarged blood vessels) that are quite severe. Although this type of surgical treatment is associated with the greatest rate of complications, it is the most effective treatment for hemorrhoids.⁽³⁾

Surgical removal of hemorrhoids through hemorrhoidectomy can include a complication, where there might be damage to the anal sphincters, and this can result in incontinence in some patients.⁽⁴⁾ The size and function of the anal sphincters can be affected (although modern techniques aim to minimize the damage).

Fistulostomy is the most common and effective treatment for anal fistulas. It involves cutting along the whole length of the anal fistula to open it up. However, this procedure is suitable only for fistulas that do not pass through much of the sphincter muscles, and it is because the risk of incontinence is lowest in such cases.

Surgical repair of anal fistulas through fistulotomy can have complications related to anal sphincters, which include damage to the sphincter.

Prostrate surgery and urethral surgery are two major surgical procedures that might have an impact on the size of urethral sphincters.

Prostate cancer is the second most common type of cancer in men worldwide.⁽⁵⁾ Prostrate surgery is the surgical method that treats diseases affecting the prostate gland, including prostate cancer and other noncancerous conditions. The surgery could include partial or complete removal of the prostate in the affected individuals.

Procedures like prostatectomy or transurethral resection of the prostate (TURP) might impact the urethral sphincters, and this can sometimes lead to temporary or permanent changes in urinary continence.

Urethral surgeries are prescribed when someone has difficulty urinating and the reason behind it could be the presence of scar tissue that causes a narrowing of the urethra. Repairing of the urethra can be done by urethral surgery or urethroplasty. The best thing about this surgery is that it has a great success rate. However, this surgery can also affect the function and size of the urethral sphincter.

Pneumatic dilation is an endoscopic therapy used to treat achalasia (a swallowing disorder that affects the esophagus). This has an impact on the size and function of the esophageal sphincter. An air-filled cylinder-shaped balloon disrupts the muscle fibers of the lower esophageal sphincter, which remains extremely tight in patients with achalasia.

The endoscopist passes a catheter with a deflated balloon through the patient’s mouth and into the stomach. The deflated balloon is centered over the lower esophageal sphincter (LES) and inflated with air. The principle of the pneumatic dilation procedure is to weaken the muscle fibers of the lower esophageal sphincter.

Sometimes the anal opening in some people is smaller than it should be. This can lead to several medical complications and if left unattended, the opening might tighten further.

Dilation is done through a series of anal dilators of varying sizes. The anal dilation is a safe procedure and helps stretch or dilate the size of the anus sphincter.

Urethral dilation also affects the size of the sphincter. It is a simple procedure used to stretch or dilate the urethra. A small tube or catheter is passed into the urethra and then it is removed again.⁽⁶⁾

Usually, urine is stored in the urinary bladder and when the right time arrives, the brain sends a message to contract the bladder muscles and relax the sphincter muscles, thus allowing urine to be expelled. However, at times, there is a narrowing in the urethral sphincter which makes emptying the urinary bladder difficult. This is where urethral dilation comes into action.

After surgery or any medical intervention, there can be changes in sphincter sizes. These changes in sphincter sizes can have varying impacts on a patient’s quality of life. Let us see some of how patients’s quality of life gets affected by these changes.

After this surgery, some patients experience changes in their bowel habits, which include temporary fecal incontinence. This can make them feel uncomfortable throughout the day and can ruin their daily activities.

Fistula repair in the anus can result in changes in the size and function of the anal sphincter and with this, patients can experience alterations in bowel movements.

Urethral surgeries can impact urinary function and certain medical interventions can cause changes in the urethral sphincter.

After prostate surgery, patients might experience stress urinary incontinence, particularly immediately after surgery.

Fundoplication and other anti-reflux surgeries can impact the ability to prevent stomach contents from flowing back to the esophagus and this can significantly have potential side effects like changes in eating habits in the patients.

NOTE: Changes in the size and function of the sphincter can have psychological effects, resulting in stress and anxiety, particularly if patients experience difficulties with their normal bodily functions.

Although surgeries and other medical interventions are essential for treating various conditions, there might also be changes in the size and function of sphincters, they might also impact the quality of life in the patients. So, it is always crucial to discuss the potential benefits and side effects of the surgery and other essentials, with your healthcare provider.

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