treatment in Melbourne
Some people notice small leaks that stain underwear. Others feel a sudden, overwhelming urge and cannot reach a toilet in time. A third group passes stool without knowing it has happened, often during sleep or after a bowel motion that felt complete.
None of these patterns are rare. Population studies across Australia and internationally estimate that somewhere between 5-15% of adults experience some degree of faecal incontinence, and the figure climbs with age. Women are affected more often than men, largely because of childbirth. Despite these numbers, most people wait years before raising it with a doctor. Many never mention it at all.
That delay carries a cost. Faecal incontinence reshapes daily life in ways that are difficult to explain to someone who has not lived with it. But the clinical reality is often more hopeful than most patients expect. Continence depends on several structures working together, and when one fails, careful assessment from a colorectal surgeon usually identifies which one. Treatment then targets that specific problem rather than offering generic advice.
Dr Naseem Mirbagheri is a general and colorectal surgeon with a particular interest in pelvic floor disorders and faecal incontinence. She holds Fellowship of the Royal Australasian College of Surgeons and completed advanced colorectal training, along with a PhD through the University of Sydney examining anorectal physiology and neuromodulation. Her practice covers established treatment options, from pelvic floor rehabilitation and medical management through to sphincter repair and sacral nerve stimulation.
Holding stool relies on a coordinated system. The internal anal sphincter maintains resting pressure and works involuntarily, keeping the anal canal closed throughout the day. The external anal sphincter and puborectalis muscle provide voluntary squeeze when urgency strikes. The rectum stores stool and must stretch to accommodate it. Sensory nerves detect arrival of contents and distinguish wind from liquid from solid. The pudendal nerve and sacral nerve roots carry those signals in both directions.
Damage to any single component can cause leakage. Damage to several, which is common, produces more severe symptoms. Understanding which part has failed drives everything that follows.
Obstetric injury remains the leading cause in women. Forceps delivery, prolonged second stage, large birthweight and third or fourth degree tears all increase risk. Symptoms sometimes appear immediately after birth, but many women stay continent for decades and then deteriorate around menopause as tissue quality changes and muscle bulk declines.
Previous anorectal surgery can also contribute. Fistula surgery, haemorrhoidectomy and sphincterotomy each carry a small risk of reducing sphincter function, particularly when the sphincter was already borderline.
Neurological conditions including multiple sclerosis, spinal cord injury, diabetes with autonomic neuropathy and stroke interrupt the nerve signalling that continence depends on. Pudendal neuropathy from chronic straining produces a similar result more gradually.
Other contributors include inflammatory bowel disease, previous pelvic radiotherapy, rectal prolapse, chronic diarrhoea and constipation with overflow. That last one surprises people. A loaded rectum stretches the sphincter open and liquid stool tracks around the impacted mass.
Dr Naseem Mirbagheri begins with a detailed history covering symptom pattern, stool consistency, obstetric background, previous surgery, medications and the practical impact on your life. Examination includes inspection and digital assessment of resting and squeeze pressures.
Anorectal physiology testing measures sphincter pressures objectively. Endoanal ultrasound or MRI shows whether the internal and external sphincters are intact or have a defect. These results distinguish a structural tear that might be repaired from a functional or neurological problem that responds better to neuromodulation. Colonoscopy may be arranged when bowel habit has changed or bleeding is present.
First-line treatment works well for a substantial proportion of patients and should always be tried properly before surgery. Stool consistency is the single biggest lever. Loose stool is far harder to hold than formed stool, so soluble fibre supplements, loperamide in small titrated doses and dietary adjustment often produce meaningful improvement within weeks.
Pelvic floor physiotherapy with biofeedback retrains the external sphincter and improves rectal sensation. Results depend heavily on the therapist’s expertise and your consistency with the programme. Bowel retraining, planned evacuation and transanal irrigation help selected patients, particularly those with neurological disease or evacuation difficulty.
Sacral nerve stimulation has changed the treatment landscape more than any other development. A thin electrode placed near the S3 nerve root delivers low-level electrical stimulation that modulates the neural pathways controlling the rectum, sphincters and pelvic floor. It works on sensation, motor function and reflex activity together, which explains why it helps patients with intact sphincters and those with defects.
Published series report that around 70 to 80% of patients who complete a successful trial maintain meaningful improvement, with substantial numbers sustaining benefit at five years and beyond.
When imaging shows a discrete external sphincter defect, usually from obstetric injury, overlapping sphincteroplasty brings the torn ends together and restores the muscle ring. Early results are good, with most patients reporting significant improvement in the first year or two.
Long-term data tempers that picture. Continence often deteriorates over five to ten years as the repair stretches and muscle quality declines. For this reason Dr Mirbagheri reserves sphincter repair for patients with a clear, sizeable defect and reasonable muscle quality, and discusses the likely trajectory honestly rather than presenting it as a permanent fix.
Dr Mirbagheri is a general and colorectal surgeon in Melbourne with a subspecialty interest in pelvic floor disorders. Her PhD through the University of Sydney examined faecal incontinence and sacral nerve stimulation directly, which means her understanding of this condition comes from original research as well as operative experience.
That background matters at the decision point. Choosing between conservative management, sphincter repair and neuromodulation requires interpreting physiology results, imaging and symptom patterns together, then matching them to what the evidence actually supports. Dr Mirbagheri approaches these consultations without rushing and explains the reasoning behind each option, including its limitations.
Dr Naseem performs surgical procedures, including faecal incontinence treatment and SNS, at St John of God and the Epworth hospitals in Melbourne, as well as offering consultations from her offices in Richmond and Berwick. If you believe that Dr Naseem is the right surgeon for your particular case, please contact us today to book an appointment.
Alternatively, use our online referral page to fill in the form and attach your referral letter and Dr Naseem’s secretary will be in touch within 24-hours to book an appointment.
This page provides general information only. It isn’t a substitute for individual medical advice. Any surgical procedure carries risks, and outcomes vary between patients. Discuss your own circumstances with a qualified health practitioner.