Four years after hemorrhoidectomy with lateral internal sphincterotomy (LIS) and fissurectomy, and currently continent, is the patient now safe from developing new fecal incontinence?

Risk of Fecal Incontinence 4 Years Post-Hemorrhoidectomy with Lateral Internal Sphincterotomy

At 4 years post-surgery with maintained continence, your risk of developing new-onset fecal incontinence is extremely low and you can be reassured that the critical risk period has passed.

Understanding the Timeline of Post-Surgical Incontinence

The overwhelming majority of incontinence after anal surgery manifests within the first 3 months postoperatively, not years later 1. Spontaneous improvement is rare after 3 months, which means the inverse is also true: new deterioration after successful early recovery is equally uncommon 1.

• Early manifestation is the rule: Incontinence from sphincter injury presents immediately or within weeks of surgery, not years later 2, 3
• The 3-month threshold: If continence problems were going to develop from your surgery, they would have appeared within the first 3 months 1
• Your 4-year mark: Being continent at 4 years post-procedure indicates your sphincter complex has healed successfully and adapted to the surgical changes 4

Why Incontinence Occurs After Lateral Internal Sphincterotomy

Understanding the mechanism helps explain why you're now safe:

• Internal sphincter injury is universal after lateral internal sphincterotomy, creating a characteristic distal injury pattern that reverses the normal resting pressure gradient in 89% of patients 3
• The injury is immediate and structural, not progressive—the sphincter damage occurs at the time of surgery, not gradually over years 3
• Your sphincter has compensated: Four years of maintained continence demonstrates successful adaptation to the altered sphincter anatomy 4

Incontinence Rates After Combined Procedures

The literature on your specific combination (hemorrhoidectomy + LIS + fissurectomy) shows:

• Early complications dominate: In combined stapled hemorrhoidopexy with lateral sphincterotomy, faecal urgency occurred in 3/26 patients (12%) and one patient had persistent flatus incontinence, but complete continence was restored within 10 weeks in all others 4
• No late-onset incontinence: The study showed no new incontinence developing after the initial 10-week healing period during follow-up 4
• General anal surgery data: Incontinence rates after lateral sphincterotomy range from 0-45%, but these manifest early, not as delayed complications 2

What Could Still Cause Future Incontinence (Unrelated to Your Surgery)

Your surgical risk has passed, but be aware of independent risk factors:

• Age-related sphincter weakening: Advanced age is a risk factor for incontinence, but this is a gradual process over decades, not a sudden event 2
• Future obstetric trauma (if applicable): Childbirth can cause new sphincter injuries independent of prior surgery 2, 3
• Diarrheal illnesses: Chronic diarrhea from any cause (inflammatory bowel disease, infections, medications) can overwhelm even normal sphincters 5
• Neurological conditions: New-onset neurological disorders affecting pelvic innervation 5
• Additional anal surgeries: Any future anal procedures would carry their own independent risk 2

The Critical Distinction: Surgical vs. Progressive Incontinence

Sphincteroplasty data illustrates the difference: When surgeons repair sphincter defects, success rates decline over time—only 28% remain continent at 40 months with a median relapse time of 5 years 1, 6, 7. However, this deterioration occurs because:

• The repair itself fails mechanically due to scar tissue breakdown 7
• Denervation injury from the original trauma progresses 7
• This is fundamentally different from your situation: You never had a sphincter repair—your sphincters healed primarily after the initial surgery and have remained stable for 4 years 4

Practical Reassurance

You can confidently resume normal activities without fear of delayed incontinence from your 4-year-old surgery 4. The structural changes to your sphincter are complete and stable. Your body has successfully adapted to the altered anatomy, as evidenced by 4 years of maintained continence.

If you were to develop incontinence in the future, it would be from a new, independent cause (age, illness, trauma, or additional surgery), not from delayed effects of your hemorrhoidectomy and sphincterotomy 5, 2.