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

Postpartum anal sphincter dysfunction

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      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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