An active duty woman with anal incontinence after vaginal delivery: an elusive diagnosis

Anal sphincter injury as a result of birth trauma is the leading cause of fecal incontinence in women presenting to surgical clinics. A 36-year-old active duty woman was referred to the Urogynecology Clinic at Madigan Army Medical Center for evaluation of a deficient perineal body. She reluctantly reported a 12-year history of anal incontinence since the birth of her first child, predating her entry into the naval service. Examination revealed defects of the perineum and anal sphincter resembling a cloacal deformity. Uncomplicated overlapping anal sphincteroplasty and perineorrhaphy were performed, restoring perineal anatomy and continence. Anal incontinence and other anatomic defects attributable to lacerations sustained at childbirth may go undetected during routine screening examinations. Interview and examination techniques should be emphasized in primary care settings.