How to do it: delayed sphincteroplasty for obstetric anal sphincter injury

Obstetric anal sphincter injuries are a common cause of faecal incontinence in women. Symptoms can arise immediately after delivery or have an onset many years postpartum. The anterior sphincter defect may be occult and unrecognised at the time of delivery or result from a breakdown of a primary repair. A delayed sphincteroplasty is a management option for those with persistent symptoms after a non-operative approach. Our patient is a 35-year-old female who presented with faecal urgency and incontinence to liquid stool and flatus. She was 8 months post-partum (G4P2) following a singleton vaginal delivery. She suffered a sphincter injury following a precipitous labour, described as a grade 3c perineal tear, which was repaired at the time in the operating theatre. Endoanal ultrasound revealed a persistent 40% defect in the anterior internal and external anal sphincters. Our approach to a delayed sphincteroplasty is described in detail. We employed a method that involved the identification, careful dissection, and separate repair of both anal sphincter muscles.