Anal incontinence is characterized by the inability to voluntarily control the expulsion of stool, bowel contents, or fecal matter at socially acceptable times and locations in both men and women over the age of four years. This condition can lead to severe psychological and social distress, resulting in social isolation, diminished self-esteem, self-confidence, and even depression.
A short walk-through of our Lucknow clinic, plus a brief introduction from Dr. Amit Agarwal.
A quick tour of Kayakriti clinic, Lucknow
Meet Dr. Amit Agarwal
Anal incontinence is characterized by the inability to voluntarily control the expulsion of stool, bowel contents, or fecal matter at socially acceptable times and locations in both men and women over the age of four years. This condition can lead to severe psychological and social distress, resulting in social isolation, diminished self-esteem, self-confidence, and even depression.
Anal incontinence is considered a common but significantly underreported condition due to the embarrassment it causes. It has an estimated prevalence of 2.2% in the general population and can affect people of all ages. It is more common in older adults, although it should not be regarded as a normal part of aging. Females are more likely to develop anal incontinence, with 63% of those affected over the age of thirty being females.
Anal incontinence has various causes, with trauma during childbirth and complete perineal tears being the most common. Additionally, surgeries in the perineal and anal regions can lead to this condition. For instance, it can occur after surgery for fissures, piles, fistula, cancer , and anal dilatation. Other factors, such as injury following trauma or accidents, can also contribute to the development of anal incontinence.
The diagnosis of anal incontinence involves several steps, including:
Thorough History: A detailed history is taken, including symptoms, bowel habits, dietary factors, medications, and other medical conditions.
Digital Rectal Examination: This examination assesses the resting pressure and voluntary contraction (maximum squeeze) of the anal sphincter. It can reveal significant sphincter dysfunction and the patient’s ability to exert voluntary control over the sphincter.
Anorectal Manometry: This test records the pressure exerted by the anal sphincters and puborectalis muscles at rest and during contraction, both before and after defecation.
When the anal sphincter is found to be torn or injured, it can be repaired. If the margins of the cut muscle sphincter are visible and the damage is limited, the repair can be performed. This repair is typically done by gynecologists or general surgeons.
Plastic surgeons play a crucial role in the management of anal incontinence when initial surgical treatments have failed or when the damage is extensive, making local tissue repair challenging. The management of anal incontinence often involves a gracilis sling operation to encircle the anal sphincter. The gracilis muscle serves as an inert sling that offers passive resistance to the outflow of bowel contents. This procedure has a success rate ranging from 60% to 90%.
The surgery for anal incontinence is usually performed under regional anesthesia, with the patient in the lithotomy position. Dr. Amit Agarwal harvests the gracilis muscle from the patient’s thigh. Three small longitudinal incisions are made on the inner aspect of the thigh. The muscle’s tendon is then introduced into a perianal tunnel at the sides and back of the anorectal region. The muscle is wrapped around the anal canal and reattached by stitches to the ischium (seat bone). A digital examination is performed after the sling is created to ensure that the sphincter functions effectively.
Patients also undergo a period of training and exercises to learn to voluntarily contract and relax the gracilis muscle.
Bowel training involves understanding how the gracilis muscle contracts and relaxes. The muscle contracts when the thigh is abducted (spread outward), and it can be made to relax by assuming a squatting position, preventing abduction of the leg. On the other hand, the sphincter can be relaxed by squatting and avoiding abduction, while it can be contracted by standing and spreading the leg outward.
A visual reference to the anatomy and the approach used at Kayakriti — illustrating the affected structures and the corrective procedure plan.
Images shown are intended to provide general procedure insight only. Actual scans vary by patient and clinical situation.
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"My big brother had a critical accident in August 2025 — his right foot was injured badly. Thanks to Dr Amit, the plastic surgery was a great success and now he is walking on his feet. Dr Amit is polite, humble, and guided us like family."
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"Dr Amit Agarwal performed cosmetic surgery on my nephew, who was facing a lot of issues with confidence due to gynaecomastia. After Dr Amit's treatment he is much better and has a boosted confidence level."
"I met a road accident two months back and my ring finger fractured. My orthopaedic doctor recommended Dr Amit for the joint fracture management. After he operated, my condition is much better."
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"My patient wasn't satisfied with the aesthetic appearance of her lips. Dr Amit performed a lip augmentation surgery — it made her lips look more full and richer. She is very satisfied with the results."
"We were very troubled after my son met a road accident in which his jaw got fractured. Dr Amit confirmed the diagnosis quickly and proceeded for the surgery — through plating he joined the bones of the jaw and stabilised it. The condition now is much better."
"My brother is diabetic and hurt his leg; the wound was not healing for a long time. Dr Amit debrided all the infected part and covered it with a flap. The wound is now healed — we are lucky we got the correct treatment on time."
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