Loperamide has this effect and may enhance sphincter function. Simple perineal exercises, in which the patient repeatedly contracts the sphincters, perineal muscles, and buttocks, may strengthen and hypertrophy these structures and may contribute to continence, particularly in mild cases. Biofeedback, used to train the patient to use the sphincters maximally and to better appreciate physiologic stimuli, should be considered before recommending surgery in well-motivated patients who can understand and follow instructions and who have an anal sphincter capable of recognizing the cue of rectal distention. Increasing the anterior angulation of the rectum may also help. In sphincteroplasty, the sphincter is sutured directly to repair a defect.
Experimental studies are underway in which a pacemaker is applied to the gracilis muscle.
If this approach is not possible, a Thiersch wire or other materials can be used to encircle the anus. When all else fails, a colostomy can be considered. All rights reserved.