Obstetric Anal Sphincter Injury

March 1, 2006

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 perinealtear was repaired after the birth.

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 perinealtear was repaired after the birth.A very attenuated perineal body with poor resting and squeeze pressureswas noted on digital rectal examination. The anovaginal septum wasscarred and foreshortened. Results of a flexible sigmoidoscopic examinationwere normal.An unrecognized or improperly repaired traumatic tear to the sphinctermuscles can occur after a vaginal birth. A midline episiotomy is associatedwith an increased risk of sphincter damage.1 Surgical repair after careful anorectalassessment and evaluation of the severity of anal incontinence is usuallysuccessful.This patient underwent overlapping sphincteroplasty to repair the analsphincter. The procedure restored complete anal continence.

References:

REFERENCE:

1.

Thorp JM Jr, Bowes WA Jr, Brame RG, Cefalo R. Selected use of midline episiotomy: effect on perinealtrauma.

Obstet Gynecol

. 1987;70:260-262.