A 26-year-old woman complained of flatus and fecal incontinence of solid stool.
One year earlier, she was delivered of a 3.86-kg (8.5-lb) infant; a severe perineal
tear was repaired after the birth.
A very attenuated perineal body with poor resting and squeeze pressures
was noted on digital rectal examination. The anovaginal septum was
scarred and foreshortened. Results of a flexible sigmoidoscopic examination
An unrecognized or improperly repaired traumatic tear to the sphincter
muscles can occur after a vaginal birth. A midline episiotomy is associated
with an increased risk of sphincter damage.1 Surgical repair after careful anorectal
assessment and evaluation of the severity of anal incontinence is usually
This patient underwent overlapping sphincteroplasty to repair the anal
sphincter. The procedure restored complete anal continence.
1. Thorp JM Jr, Bowes WA Jr, Brame RG, Cefalo R. Selected use of midline episiotomy: effect on perineal
trauma. Obstet Gynecol. 1987;70:260-262.