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Anal-sphincter disruption during vaginal delivery
A H Sultan1, M A Kamm, C N Hudson
1St. Mark's Hospital, London, United Kingdom.
The New England Journal of Medicine
|December 23, 1993
Summary
Occult anal sphincter defects are common after vaginal delivery, particularly with forceps use, and frequently lead to bowel dysfunction. These injuries impact anorectal function and can cause fecal incontinence symptoms.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Pelvic Floor Disorders
Background:
- Anal sphincter lacerations and nerve damage during childbirth are primary causes of fecal incontinence.
- The incidence and significance of occult sphincter damage from routine vaginal delivery remain unclear.
Purpose of the Study:
- To determine the incidence of anal sphincter damage after vaginal delivery.
- To investigate the relationship between sphincter injury, symptoms, anorectal function, and delivery mode.
Main Methods:
- 202 women were studied pre- and post-delivery (6 weeks, 6 months).
- Assessments included anal incontinence symptoms, endosonography, manometry, and pudendal nerve terminal motor latency.
- Delivery modes (vaginal, cesarean, forceps, vacuum) were analyzed.
Main Results:
- 13-23% of women delivering vaginally reported incontinence/urgency 6 weeks postpartum.
- 35-44% had sphincter defects on endosonography, persisting at 6 months.
- Forceps delivery was associated with higher rates of sphincter defects (80%) compared to vacuum extraction (0%).
- Sphincter defects correlated with reduced resting and squeeze anal pressures and increased bowel symptoms (P < 0.001).
Conclusions:
- Occult anal sphincter defects are prevalent after vaginal delivery, especially with forceps.
- These defects are frequently linked to impaired bowel function and symptoms of fecal incontinence.