Incontinence after fistulotomy in low anal fistula: Can Kegel exercises help improve postoperative incontinence?

Aim: Fistulotomy is the commonest procedure performed for low anal fistulas. The incidence of gas and urge incontinence after fistulotomy and whether Kegel exercises (KE) could help recover sphincter function after fistulotomy has not been studied before. Methods: Patients operated with fistulotomy for low fistulas were recommended KE (pelvic contraction exercises) 50 times/day for one year postoperatively. Incontinence (solid, liquid, gas, and urge) was evaluated objectively (Vaizey’s scores) preoperatively [Pre-op Group], in the immediate postoperative period [Pre-KE Group], and at 6-month follow-up [Post-KE Group]. Incontinence scores in all three groups were compared to evaluate the efficacy of KE. Results: As many as 101 MRI-documented low anal fistula patients were included. There were 79 males (mean age 39.4 ±12.9 years) and the median follow-up was 12 months (6–18 months). Two patients were lost to follow-up. Fistulas healed in all the patients. Incontinence was present in 5/99 patients (mean incontinence scores –0.13 ±0.63) preoperatively and occurred in 20/99 (mean incontinence scores –1.03 ±2.18) patients postoperatively (Pre-KE Group). With KE, the incontinence improved completely in 10 and partially in another 10 (mean incontinence scores –0.31 ±1.09) patients. Urge and gas incontinence accounted for most cases (80%). The mean incontinence scores deteriorated significantly after fistulotomy (pre-op vs pre-KE, p = 0.000059, significant) but continence improved significantly with KE, thus the scores between pre-op and post-KE became comparable (pre-op vs post-KE, p = 0.07, not significant). Conclusions: Fistulotomy, even in low fistulas, can lead to a significant increase in gas and urge incontinence. Regular Kegel exercises postoperatively can help recover lost sphincter function and can bring back continence comparable to preoperative levels.