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Gynaecology| Volume 9, ISSUE 4, P210-215, December 1999

Postpartum anal sphincter dysfunction

DOI:https://doi.org/10.1054/cuog.1999.0042
Postpartum anal sphincter dysfunction
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      Abstract

      Faecal incontinence presents with a female to male ratio of 8:1 suggesting childbirth as the principal causative factor, although most women do not become symptomatic until after menopause. Obstetric injury may arise as a result of direct muscular damage to the anal sphincter, as occurs during a third-degree tear, and/or may be the result of cumulative damage to the pudendal nerves. Symptomatic women should be assessed in a dedicated clinic where time is available for comprehensive evaluation. Clinical examination alone may fail to detect specific abnormalities. The performance of anal manometry, endoanal ultrasound and neurophysiology studies of the pelvic floor will increase the diagnostic yield. Treatment may include dietary manipulation and physiotherapy. In severe cases surgery may be warranted with secondary repair of the anal sphincter muscle. Adequate primary management of third-degree tears requires careful appraisal so as to reduce the incidence of later incontinence.
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      References

      REFERENCES

        • Leigh R.J.
        • Turnberg L.A.
        Faecal incontinence: the unvoiced symptom.
        Lancet. 1982; 1: 1349-1351
        • Glazener C.M.
        • Abdulla M.
        • Stroud P.
        • Naji S.
        • Templeton A.
        • Russell I.
        Postnatal maternal morbidity: extent, causes, prevention and treatment.
        Br J Obstet Gynaecol. 1995; 102: 282-287
        • Gjerdingen D.K.
        • Froberg D.G.
        • Chaloner K.M.
        • McGovern P.M.
        Changes in women’s health during the first postpartum year.
        Arch Fam Med. 1993; 2: 277-283
        • Donnelly V.S.
        • Fynes M.
        • Campbell D.M.
        • Johnson H.
        • O’Connell P.R.
        • O’Herlihy C.
        Obstetric events leading to anal sphincter damage.
        Obstet Gynecol. 1998; 92: 955-961
        • Sultan A.H.
        • Kamm M.A.
        • Hudson C.N.
        • Bartram C.I.
        Anal sphincter disruption during vaginal delivery.
        N Eng J Med. 1993; 329: 1905-1911
        • Thacker S.B.
        • Banta H.D.
        Benefits and risks of episiotomy: an interpretative review of the English language literature 1860–1980.
        Obstet Gynecol Surv. 1983; 38: 322-338
        • Snooks S.J.
        • Setchell M.
        • Swash M.
        • Henry M.M.
        Injury to innervation of pelvic floor musculature in childbirth.
        Lancet. 1984; ii: 546-550
        • Parks A.G.
        • Swash M.
        • Urich H.
        Sphincter denervation in anorectal incontinence and rectal prolapse.
        Gut. 1977; 18: 656-665
        • Sultan A.H.
        • Kamm M.A.
        • Hudson C.N.
        Pudendal nerve damage during labour: a prospective study before and after childbirth.
        Br J Obstet Gynaecol. 1994; 101: 22-28
        • Jorge J.M.
        • Wexner S.D.
        Etiology and management of faecal incontinence.
        Dis Colon Rectum. 1993; 36: 77-79
        • Perry R.E.
        • Blantchford G.J.
        • Christensen M.A.
        • Thorson A.G.
        • Attwood S.E.
        Manometric diagnosis of anal sphincter injuries.
        Am J Surg. 1990; 159: 112-117
        • Williams N.
        • Barlow J.
        • Hobson A.
        • Scott N.
        • Irving M.
        Manometric asymmetry in the anal canal in controls and patients with faecal incontinence.
        Dis Colon Rectum. 1995; 38: 1275-1280

      13. Bartram, C. I. Burnett, S. J. D. Atlas of anal endosonography. Oxford, Butterworth-Heinemann, 1997, 7, 16

        • Sentovich S.
        • Wong D.
        • Blatchford G.
        Accuracy and reliability of transanal ultrasound for anterior sphincter injury.
        Dis Colon Rectum. 1998; 41: 1000-1004
        • Rogers J.
        • Henry M.M.
        • Misiewicz J.J.
        Disposable pudendal nerve stimulation: Evaluation of the standard instrument and new device.
        Gut. 1988; 29: 1131-1133
        • Wexner S.D.
        • Marchetti F.
        • Salanga V.D.
        • Corredone D.F.
        Neurophysiologic assessment of the anal sphincter.
        Dis Colon Rectum. 1991; 34: 606-612
        • Read M.
        • Read N.W.
        • Barber D.C.
        • Duthie H.
        The effect of loperamide on anal sphincter function in patients complaining of chronic diarrhoea with fecal incontinence.
        Dig Dis Sci. 1982; 27: 807-814
        • Fynes M.
        • Marshall K.
        • Cassidy M.
        A prospective, randomised study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma.
        Dis Colon Rectum. 1999; 42(6): 753-758
        • Oliveira L.
        • Pfeifer J.
        • Wexner S.D.
        Physiological and clinical outcome of anterior sphincteroplasty.
        Br J Surg. 1996; 83: 502-505
        • Arnaud A.
        • Sarles J.C.
        • Sielezneff I.
        • Orsoni P.
        • Joly A.
        Sphincter repair without overlapping for faecal incontinence.
        Dis Colon Rectum. 1991; 34: 744-747
        • Parks A.G.
        • McPartlin J.F.
        Late repairs of injuries of the anal sphincter.
        Proc R Soc Med. 1971; 64: 1187-1189
        • Sultan A.H.
        • Monga A.
        • Kumar D.
        • Stanton S.
        Primary repair of obstetric anal sphincter rupture using the overlap technique.
        Br J Obs Gynae. 1999; 106: 318-323
        • Nielsen M.B.
        • Hauge C.
        • Rasmussen O.O.
        • Pedersen J.F.
        • Christiansen J.
        Anal endosonographic findings in the follow-up of primarily sutured sphincteric ruptures.
        Br J Surg. 1992; 79: 104-106
        • Lehur P.A.
        • Michot F.
        • Denis P.
        • Grise P.
        • Leborgne J.
        • Teniere P.
        Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantations.
        Dis Colon Rectum. 1996; 39: 1352-1355
        • Fynes M.
        • Donnelly V.
        • Behan M.
        • O’Connell P.R.
        • O’Herlihy C.
        Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study.
        Lancet. 1999; 354: 983-986

      Article info

      Identification

      DOI: https://doi.org/10.1054/cuog.1999.0042

      Copyright

      © 1999 Published by Elsevier Inc. All rights reserved.

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