BACKGROUND: The purpose of the present paper was to determine the anatomical integrity and functional effect of a tear to the anal sphincter in women after vaginal delivery. METHODS: A prospective review of third- and fourth-degree vaginal tears over a 3 year period at Lyell McEwin and Queen Elizabeth Hospitals, Adelaide. Obstetric details were obtained from the records. All were counselled by a continence advisor and offered consultation with a colorectal surgeon. The integrity of the anal sphincter was assessed by endoanal ultrasound. RESULTS: During the study period there were 6875 vaginal deliveries. There were 89 women (1.3%) who had a third- or fourth-degree tear. Fifty-one (57%) agreed to participate. Primiparity (67%), episiotomy (49%), forceps delivery (29%) and instrumental delivery were common in women sustaining a tear. Symptoms of anal incontinence (mild) or faecal urgency were described in 23 women (45%). Except for three women with an anovaginal fistula none required surgery for the management of faecal incontinence. A sphincter defect was seen in 27 women (53%) on endoanal ultrasound. The presence or absence of a sphincter defect was not significantly associated with symptoms but a trend was suggested (chi2=3.21; P=0.07). CONCLUSIONS: Third-degree tear after vaginal delivery was a significant intrapartum event, yet associated only with minimal symptoms (excluding patients with anovaginal fistula) even in the presence of a sphincter defect on anal ultrasound.
BACKGROUND: The purpose of the present paper was to determine the anatomical integrity and functional effect of a tear to the anal sphincter in women after vaginal delivery. METHODS: A prospective review of third- and fourth-degree vaginal tears over a 3 year period at Lyell McEwin and Queen Elizabeth Hospitals, Adelaide. Obstetric details were obtained from the records. All were counselled by a continence advisor and offered consultation with a colorectal surgeon. The integrity of the anal sphincter was assessed by endoanal ultrasound. RESULTS: During the study period there were 6875 vaginal deliveries. There were 89 women (1.3%) who had a third- or fourth-degree tear. Fifty-one (57%) agreed to participate. Primiparity (67%), episiotomy (49%), forceps delivery (29%) and instrumental delivery were common in women sustaining a tear. Symptoms of anal incontinence (mild) or faecal urgency were described in 23 women (45%). Except for three women with an anovaginal fistula none required surgery for the management of faecal incontinence. A sphincter defect was seen in 27 women (53%) on endoanal ultrasound. The presence or absence of a sphincter defect was not significantly associated with symptoms but a trend was suggested (chi2=3.21; P=0.07). CONCLUSIONS: Third-degree tear after vaginal delivery was a significant intrapartum event, yet associated only with minimal symptoms (excluding patients with anovaginal fistula) even in the presence of a sphincter defect on anal ultrasound.
Authors: T Aigmueller; W Bader; K Beilecke; K Elenskaia; A Frudinger; E Hanzal; H Helmer; H Huemer; M van der Kleyn; D Koelle; S Kropshofer; J Pfeiffer; C Reisenauer; A Tammaa; K Tamussino; W Umek Journal: Geburtshilfe Frauenheilkd Date: 2015-02 Impact factor: 2.915
Authors: Pierre Marie Tebeu; Joseph Nelson Fomulu; Sinan Khaddaj; Luc de Bernis; Thérèse Delvaux; Charles Henry Rochat Journal: Int Urogynecol J Date: 2011-12-06 Impact factor: 2.894