Results of sphincter repair in postobstetric fecal incontinence

Postobstetric fecal incontinence is a rare and severe complications of vaginal delivery. Most often, it is the result of a tear of the anal sphincter, pudendal neuropathy, or a combination of the two.

Thirty-six patients operated upon at our institution for postobstetric fecal incontinence during a ten year period (1983 to 1992) were questioned (score) and examined to assess the operative results.

Preoperatively, all 36 patients (mean age of 37 years, range of 24 to 70 years) had sphincter tears and 32 patients were totally incontinent (score of 16 to 18). Three patients were moderately incontinent (score of 9) and one patient was incontinent of flatus only (score of 3). Eighty percent of the patients were referred with delay. Thirty-six sphincteroplasties with various degrees of rectovaginal and perianal reconstructions were performed. Twenty-eight women (78 percent) are continent (score of zero to 3), seven patients (19 percent) are partially incontinent (score of 4 to 6), and one patient (3 percent) is totally incontinent (score of 18). There was no mortality. Among the six postoperative complications, there were two sphincter breakdowns with persistent incontinence and four minor local complications.

Careful assessment and operative management of sphincter damage at the time of delivery as well as counseling of all women at risk for fecal incontinence are essential. Sphincteroplasty is a simple and safe procedure that offers symptomatic relief in almost all patients with sphincter lesions and cure in 80 percent.