Figure 5.

Model for poor outcomes after sphincteroplasty. Hypothetical model to explain poor outcomes after sphincteroplasty: The graph shows a hypothetical time course (x-axis) of the sphincter strength (y-axis) with the dotted line representing the threshold below which incontinence becomes clinically evident. There may be a natural decline of sphincter strength (time before sphincter injury), a dramatic reduction through the injury, followed by an accelerated decline. The physiological delay represents the time until symptoms evolve, while the embarrassment delay reflects the time until a symptomatic patient acknowledges the problem. A sphincter repair may restore some strength, but with continued and possibly accelerated decline of the sphincter function the threshold is again crossed after a period of time.