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Effect of delivery on anal sphincter morphology and function
J Zetterström1, A Mellgren, L L Jensen
1Division of Obstetrics and Gynaecology, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.
Diseases of the Colon and Rectum
|October 21, 1999
Summary
Childbirth can cause anal sphincter injuries, leading to incontinence. This study found 20% of women had sphincter injuries after vaginal delivery, highlighting the need for obstetrician awareness and follow-up inquiries.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Surgical Complications
Background:
- Anal sphincter injuries are a significant childbirth complication, potentially causing persistent anal incontinence.
- Previous studies reported occult injuries up to 35% in females via endoanal ultrasonography.
Purpose of the Study:
- To investigate anal sphincter morphology and function in primiparous females before and after delivery in the United States.
- To assess the incidence of anal sphincter injuries post-vaginal delivery.
Main Methods:
- Thirty-eight primiparous patients underwent endoanal ultrasonography, anal manometry, and pudendal nerve terminal motor latency testing during pregnancy and postpartum.
- Bowel function was assessed using questionnaires before and after delivery.
- Cesarean section was performed in three patients.
Main Results:
- Clinical sphincter tears requiring repair occurred in 15% of patients.
- Post-delivery endoanal ultrasonography showed external anal sphincter disruptions in 6% of patients, with no internal sphincter disruptions.
- Pathologic findings correlated with increased left pudendal latency and reduced manometric results, particularly in those with third or fourth-degree tears.
Conclusions:
- The study identified a 20% frequency of sphincter injuries following vaginal delivery.
- Obstetricians must be aware of this risk and proactively inquire about incontinence symptoms during postpartum follow-up.