The effect of vaginal delivery on anal function

Area of Science:

• Obstetrics and Gynecology
• Gastroenterology
• Pelvic Floor Disorders

Background:

• Faecal incontinence is a common concern, with childbirth frequently cited as a primary cause.
• Understanding the incidence and risk factors post-childbirth is crucial for women's health.

Purpose of the Study:

• To review the prevalence of faecal incontinence in the community.
• To assess the incidence of incontinence following childbirth.
• To evaluate diagnostic methods and their correlation with symptoms and injuries.

Main Methods:

• Review of existing literature on faecal incontinence after childbirth.
• Analysis of studies utilizing anal manometry, neurophysiological tests, and anal ultrasound.
• Correlation of findings with delivery type (e.g., third-degree tears, forceps) and symptoms.

Main Results:

• Third-degree tears and forceps delivery are associated with increased risk of faecal incontinence symptoms.
• Reduced anal pressures are observed post-vaginal delivery, with some recovery over time.
• Sphincter defects and pudendal neuropathy are common after vaginal delivery but not always symptomatic; their long-term significance is uncertain.

Conclusions:

• Childbirth can cause occult anal sphincter injuries and nerve damage, which may not be immediately apparent.
• Current diagnostic tools like anal manometry may not reliably indicate muscle or nerve injury.
• The high prevalence of asymptomatic injuries suggests many may remain clinically insignificant, but some could lead to later-life symptoms.