Anal incontinence is a very common symptom, mainly manifested as the inability to control gas, liquid or solid feces in the anus, mildly manifested as stained feces in the underpants and a sense of urgency to defecate, and in severe cases it can manifest as the inability to control liquid or solid feces in the anus and the need to use an adult urinary pad, which affects the quality of the patient’s survival. In the outpatient clinic, in addition to some because of car accidents lead to paraplegia, neurological injuries because of anal incontinence, ordinary people because of anal incontinence clinic is very little, many people think that it is not a serious problem or embarrassed, did not carry out timely treatment, resulting in anal incontinence is getting more and more serious, and finally even need to carry out the stoma of the. In our usual clinical work, the most common causes of anal incontinence are: nerve injury caused by trauma, anal sphincter muscle and nerve injury caused by birth injury, anal muscle relaxation in elderly patients, poor anal function after low rectal cancer surgery, anal incontinence caused by anal surgery, congenital anus or abnormal muscle development. (1) Clinical assessment: patients with anal incontinence should be assessed clinically firstly, the simpler assessment method is based on whether the control of gas, liquid and solid is divided into light, medium and heavy; at present, the clinical assessment method is Wexner scoring method, which is classified into light, medium and heavy; no matter which method is used, the clinical assessment is the most important in anal incontinence. No matter which method is used, clinical assessment is the most important in anal incontinence. (2) Anal manometry: anal manometry is the most basic means of examination for anal incontinence, which can assess the function of internal sphincter, external sphincter, anorectal reflexes, rectal compliance, and preliminary examination of neurological function and other anorectal functions. (3) Defecography: Defecography is not often used, but it can indirectly reflect the incontinence characteristics and severity. (4) Pelvic floor electromyography and evoked potentials: it can reflect the function of nerves and muscles innervating the anorectal muscles such as the pubic nerve and determine whether the incontinence comes from the nerves or the muscles; the evoked potentials examination recently adopted can also assess whether it comes from the central or peripheral nerves. (5) Intracavernous ultrasound: Intracavernous ultrasound is important for judging muscle defects, especially the scope of the defects, and it is an important reference value for judging whether sphincter repair is possible; in recent years, the use of three-dimensional ultrasound has a greater diagnostic value for the sphincter. (6) Enteroscopy: mainly to exclude some organic lesions in the intestines. These tests are very important in anal incontinence, but in anal incontinence, the subjective feeling of the patient is more important, we have dealt with a patient before, because of surgical trauma, resulting in muscle and nerve damage, manometry electromyography is not very optimistic, but the patient’s subjective feeling after surgery is very good! For a patient who does not intend to undergo surgical treatment, it is meaningless to conduct so many tests, if the patient is going to undergo surgical treatment, a comprehensive assessment is very important. 2. What are the treatments for anal incontinence? In general, anal incontinence treatment effect is poor, so the key to anal incontinence in prevention, especially in the anal intestinal surgery, to prevent excessive damage to the anal sphincter, for the treatment of benign anal diseases such as anal fistula surgery, to retain the anal sphincter should be put in the first place, the efficacy of the surgery should be put in the second place in order to pursuit of efficacy to expand the scope of the surgery is meaningless! (1) general treatment: including sitz bath, keep clean, lifting the anus exercise, etc. There are also some people who use enema to achieve the purpose of intestinal cleansing. (2) Biofeedback therapy: Literature reports that biofeedback therapy for anal incontinence has some efficacy, but the long-term effect is poor. (3) Sphincter repair surgery: Generally, it is effective for birth and traumatic and surgical injuries where the sphincter damage is not more than 1/3 of the circumference, but it is necessary to exclude whether it is combined with nerve damage! And because the muscle injury is too long, muscle contracture for a long time leads to the decline of muscle function, which may also lead to poorer postoperative results in patients. (4) thin femoral muscle transplantation sphincter repair: this surgery is applied more in foreign countries and less in China, it can be applied to anal muscle injury, sphincter reconstruction, but because thin femoral muscle is transverse muscle, fatigue will be produced after sustained contraction, so the effect is poor. Some people use sacral nerve stimulation after thin femoral muscle transplantation and report more satisfactory results, and some people apply this technique for anal reconstruction after low rectal surgery. (5) Artificial sphincter surgery: this surgery is used more abroad and less domestically, and patients have more long-term complications, including perineal ulcers, pain, infection and other complications, and about 60% of the patients need to remove or re-open the artificial sphincter surgery after the surgery because of various complications. (6) Sacral Nerve Stimulation (SNS): also known as sacral neuromodulation, is a kind of medical electrical stimulation therapy, usually implanted in the subcutaneous programmable stimulator (i.e., sacral nerve stimulator), which connects to the sacral nerves through the lead wire and sends out low-amplitude electrical stimulation, which causes the contraction of the external sphincter and pelvic floor muscles, and improves incontinence, defecation dysfunction due to the pelvic floor laxity, and also improves the incontinence of the anus, primary anorectal pain and other diseases. anorectal pain and other diseases. In the treatment of anal incontinence, about 70% of the patients can be improved by sacral nerve stimulation, especially for the anal incontinence caused by pelvic floor relaxation, and the decline of anal function caused by the low level resection of rectal cancer, etc. It has a more ideal curative effect. (7) Colostomy: when all treatments are ineffective, stoma is needed. Although stoma has some inconvenience, it is still an ideal choice for those whose quality of life is seriously affected by anal incontinence! Anal incontinence is indeed one of the more common diseases, but one that is not taken seriously.