Chapter 94 - Part E: Successful Surgery, Failed Continence: The Rectal Physiology Trap

In this BoardsCast episode, we finish Tobias Chapter 94 — Rectum, Anus, and Perineum by tackling the scenario that breaks surgeons:

The incision healed… and the dog is incontinent.

This is the rectal physiology trap: we grade success by closure, but the owner grades success by function. And in rectal surgery, healing does not equal continence.

You’ll learn the continence system as a four-part machine — and why damaging even one component can turn a technically “perfect” procedure into a life-altering failure:

• Internal anal sphincter (IAS): the automatic baseline seal
• External anal sphincter (EAS): voluntary control via the caudal rectal branch of the pudendal nerve
• Rectal reservoir/compliance: the “storage tank” that prevents pressure spikes
• Neurologic control: the wiring harness (pudendal/pelvic/hypogastric pathways)

Then we break down the three killers that drive post-op incontinence:

denervation, tension, and loss of compliance — plus the deceptive timeline where swelling masks failure early, and the “real score” shows up weeks later.

Bottom line: you don’t win when the incision heals. You win when the patient stays continent.

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