Primary surgical repair for fecal incontinence is indicated in which of the following scenarios?

• A. Traumatic injury to sphincters
• B. Insufficient rectal compliance
• C. Encopresis
• D. The persistence of incontinence 9 months after surgical correction

Answer: (A)

When fecal incontinence results from a fresh, discrete tear in the anal sphincters due to trauma, direct surgical repair to rejoin the torn ends is the best initial step. Reapproximating the sphincter ends restores the barrier that the sphincter normally provides, allowing the muscle to generate a proper resting tone and squeeze during defecation. Doing this repair promptly yields better healing and function because the tissue is healthier and less scarred, making it easier to restore continuity and closure.

The other scenarios involve problems that aren’t about a torn sphincter. Insufficient rectal compliance means the rectum can’t accommodate stool, which isn’t fixed by repairing the sphincter. Encopresis in children is often functional or related to stool withholding, not a structural sphincter injury. Persistence of incontinence after prior surgery suggests a different problem or failed repair, and would lead to alternative management rather than a primary sphincter repair.