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Obstetric Lesions: The Gynaecologist’s Point of View

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Fecal Incontinence

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Abstract

Data from the obstetrical literature show that about 0.4-3.7% of all vaginal deliveries result in a thirdor fourth-degree perineal laceration [1, 2]. Rarely, the reported incidence can go as high as 20–39% [3, 4]. When a third- or fourth-degree perineal laceration occurs during vaginal delivery, the standard repair is to approximate the torn ends of the anal sphincter using two to six interrupted mattress or figure-of-eight stitches and close the vaginal and perineal tissues in layers. Postpartum, the patient is typically put on a soft diet and given a stool softener for 7–10 days. This method of repair is described in the latest edition of Williams Obstetrics [5], the newest edition of [6], and numerous other obstetrical textbooks.

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References

  1. Haadem K, Gudmundsson S (1997) Can women with intraprtum rupture of anal sphincter still suffer after-effects two decades later. Acta Obstet Gynecol Scand 76:601–603

    PubMed  CAS  Google Scholar 

  2. Jander C, Lyrenas S (2001) Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand 80:229–234

    Article  PubMed  CAS  Google Scholar 

  3. O’Leary JL, O’Leary JA (1965) The complete episiotomy. Analysis of 1224 complete lacerations, sphincterotomies, and episiproctomies. Obstet Gynecol 25:235–240

    PubMed  CAS  Google Scholar 

  4. Sieber EH, Kroon JD (1962) Morbidity in the third degree laceration. Obstet Gynecol 19:677–680

    PubMed  CAS  Google Scholar 

  5. Cunningham FG, Leveno KJ, Bloom SL et al (eds) (2005) Williams Obstetrics, 22nd edn. McGraw-Hill, New York

    Google Scholar 

  6. Gabbe SG, Niebyl JR, Simposn JL (eds) (2002) Obstetrics, normal and problem pregnancies, 4th edn. Churchill Livingston, Philadelphia

    Google Scholar 

  7. Zetterstrom J, Lopez A, Anzen B et al (1999) Anal sphincter tears at vaginal delivery: Risk factors and clinical outcome of primary repair. Obstet Gynecol 94:21–28

    Article  PubMed  CAS  Google Scholar 

  8. Pollack J, Nordenstam J, Brismar S et al (2004) Anal incontinence after vaginal delivery: A five year prospective cohort study. Obstet Gynecol 104: 1397–1402

    PubMed  Google Scholar 

  9. Crawford LA, Quint EH, Pearl ML (1993) Incontinence following rupture of the anal sphincter during delivery. Obstet Gynecol 82:527–531

    Article  PubMed  CAS  Google Scholar 

  10. Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872

    Article  PubMed  Google Scholar 

  11. Nygaard IE, Rao SSC, Dawson JD (1997) Anal incontinence after anal sphincter disruption: A 30-year retrospective study. Obstet Gynecol 89:896–901

    Article  PubMed  CAS  Google Scholar 

  12. Faltin DL, Otero M, Petignat P et al (2006) Women’s health 18 years after rupture of the anal sphincter during childbirth: I. Fecal incontinence. Am J Obstet Gynecol 194:1255–1259

    Article  PubMed  Google Scholar 

  13. Wagenius J, Laurin J (2003) Clinical symptoms after anal sphincter rupture: A retrospective study. Acta Obstet Gynecol Scand 82:246–250

    Article  PubMed  Google Scholar 

  14. Fornell EU, Matthiesen L, Sjodhl R et al (2005) Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG 112:312–316

    Article  PubMed  Google Scholar 

  15. Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18:656–665

    Article  PubMed  CAS  Google Scholar 

  16. Bartolo DEC, Jarratt JA, Read MG et al (1983) The role of partial denervation of the puborectalis in idiopathic fecal incontinence. Br J Surg 70:664–667

    Article  PubMed  CAS  Google Scholar 

  17. Kiff ES, Swash M (1984) Slowed conduction in the pudendal nerves in idiopathic fecal incontinence. Br J Surg 71:614–616

    Article  PubMed  CAS  Google Scholar 

  18. Sultan AH, Kamm MA, Hudson CN et al (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891

    PubMed  CAS  Google Scholar 

  19. Nielsen MB, Hauge C, Rasmussen 00 et al ( 1992) Anal endosonographic findings in the follow-up of primary sutured sphincteric ruptures. Br J Surg 79:104–106

    Article  PubMed  CAS  Google Scholar 

  20. Gjessing H, Backe B, Sahlin Y (1998) Third degree obstetric tears: outcome after primary repair. Acta Obstet Gynecol Scand 77:736–740

    Article  PubMed  CAS  Google Scholar 

  21. Poen AC, Felt-Bersma RJF, Strijers RLM et al (1998) Third-degree obstetric perineal tear: long term clinical and functional results after primary repair. Br J Surg 85:1433–1438

    Article  PubMed  CAS  Google Scholar 

  22. Belmonte-Montes C, Hagerman G, Vega-Yepez PA et al (2001) Anal sphincter injury after vaginal delivery in primiparous females. Dis Colon Rectum 44:1244–1248

    Article  PubMed  CAS  Google Scholar 

  23. Norderval S, Oian P, Revhaug A et al (2005) Anal incontinence after obstetric sphincter tears: Outcome of anatomic primary repair. Dis Colon Rectum 48:1055–1061

    Article  PubMed  Google Scholar 

  24. Parks AG, McPartlin JF (1971) Late repairs of injuries of the anal sphincter. Proc R Soc Med 64:1187–1189

    PubMed  CAS  Google Scholar 

  25. Sultan AH, Monga AK, Kumar D et al (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. BJOG 106:318–323

    Article  CAS  Google Scholar 

  26. Kairaluoma MV, Raivio P, Aarnio MT et al (2004) Immediate repair of obstetric anal sphincter rupture: Medium-term outcome of the overlap technique. Dis Colon Rectum 47:1358–1363

    Article  PubMed  Google Scholar 

  27. Fitzpatrick M, Fynes M, Cassidy M et al (2000) Prospective study of the influence of parity and operative technique on the outcome of primary anal sphincter repair following obstetric injury. Eur J Obstet Gynecol Reprod Biol 89:159–163

    Article  PubMed  CAS  Google Scholar 

  28. Jorge J, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–79

    Article  PubMed  CAS  Google Scholar 

  29. Fitzpatrick M, Behan M, O’Connell PR et al (2000) A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 183:1220–1224

    Article  PubMed  CAS  Google Scholar 

  30. Garcia V, Rogers R, Kim SS et al (2005) Primary repair of obstetric anal sphincter laceration: A randomized trail of two surgical techniques. Am J Obstet Gynecol 192:1697–1701

    Article  PubMed  Google Scholar 

  31. Kammerer-Doak DN, Wesol AB, Rogers RG et al (1999) A prospective cohort study of women after primary repair of obstetric anal sphincter laceration. Am J Obstet Gynecol 181:1317–1323

    Article  PubMed  CAS  Google Scholar 

  32. Fernando RJ, Sultan AH, Kettle C et al (2006) Repair techniques for obstetric anal sphincter injury. Obstet Gynecol 107:1261–1268

    PubMed  Google Scholar 

  33. Rockwood TH, Church JM, Fleshman JW et al (2000) Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16

    Article  PubMed  CAS  Google Scholar 

  34. Nazir M, Stien R, Carlsen E et al (2003) Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading. An observational cohort study. Dis Colon rectum 46:1245–1250

    Article  Google Scholar 

  35. Norderval S, Nsubuga D, Bjelke C et al (2004) Anal incontinence after obstetric sphincter tears: incidence in a Norwegian county. Acta Obstet Gynecol Scand 83:989–994

    Article  PubMed  Google Scholar 

  36. Kairaluoma MV, Raivio P, Aarnio MT et al (2004) Immediate repair of obstetric anal sphincter rupture: Medium-term outcome of the overlap technique. Dis Colon Rectum 47:1358–1363

    Article  PubMed  Google Scholar 

  37. Mahony R, Behan M, O’Herlihy C et al (2004) Randomized, clinical trial of bowel confinement vs. laxative use after primary repair of a third-degree obstetric anal sphincter tear. Dis Colon Rectum 47:12–17

    Article  PubMed  Google Scholar 

  38. Tetzschner T, Sorenson M, Gunnar L et al (1996) Anal and urinary incontinence in women with obstetric anal sphincter rupture. BJOG 103:1034–1040

    Article  CAS  Google Scholar 

  39. Spydalaug A, Trogstad LIS, Skrondal A et al (2005) Recurrent risk of anal sphincter laceration among women with vaginal deliveries. Obstet Gynecol 105:307–313

    Google Scholar 

  40. McKenna DS, Ester JB, Fischer JR (2003) Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol 189:1251–1256

    Article  PubMed  Google Scholar 

  41. Sangalli MR, Floris L, Faltin D et al (2000) Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynecol 3:244–248

    Article  Google Scholar 

  42. Ryhammer AM, Bek KM, Laurberg S (1995) Multiple vaginal deliveries increase the risk of permanent incontinence of flatus and urine in normal premenopausal women. Dis Colon Rectum 38:1206–1209

    Article  PubMed  CAS  Google Scholar 

  43. Nichols CM, Lamb EH, Ramakrishnan V (2005) Differences in outcome after third-versus fourth-degree perineal laceration repair: A prospective study. Am J Obstet Gynecol 193:530–536

    Article  PubMed  Google Scholar 

  44. Fynes M, Donnelly VS, O’Connell PR et al (1998) Cesarean delivery and anal sphincter injury. Obstet Gynecol 92:496–500

    Article  PubMed  CAS  Google Scholar 

  45. Peleg D, Kennedy CM, Merrill D et al (1999) Risk of repetition of a severe perineal laceration. Obstet Gynecol 93:1021–1024

    Article  PubMed  CAS  Google Scholar 

  46. Payne TN, Carey JC, Rayburn WF (1999) Prior third-or fourth-degree perineal tears and recurrence risks. Inter J Gynecol Obstet 64:55–57

    Article  CAS  Google Scholar 

  47. Sorensen M, Tetzschner T, Rasmussen OO et al (1993) Sphincter rupture in childbirth. Br J Surg 80:392–394

    Article  PubMed  CAS  Google Scholar 

  48. Sze EHM (2005) Anal incontinence among women with one versus two complete third-degree perineal lacerations. Inter J Gynecol Obstet 90:213–217

    Article  CAS  Google Scholar 

  49. Pescatori M, Anastasio G, Bottini C et al (1992) New grading and scoring for anal incontinence. Dis Colon Rectum 35:482–487

    Article  PubMed  CAS  Google Scholar 

  50. Sze EHM (2005) Prevalence and severity of anal incontinence in women with and without additional vaginal deliveries after a fourth-degree perineal laceration. Dis Colon Rectum 48:66–68

    Article  PubMed  Google Scholar 

  51. Hannah ME, Hannah WJ, Hodnett ED et al (2002) Outcomes at 3 months after planned cesarean versus planned vaginal delivery for breech presentation at term. JAMA 287:1822–1831

    Article  PubMed  Google Scholar 

  52. Chaliha C, Kalia V, Stanton SL et al (1999) Antenatal prediction of postpartum urinary and fecal incontinence. Obstet Gynecol 94:689–694

    Article  PubMed  CAS  Google Scholar 

  53. Chaliha C, Sultan AH, Bland JM et al (2001) Anal function: Effect of pregnancy and delivery. Am J Obstet Gynecol 185:427–432

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Eddie H. M. Sze
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  2. Maria Ciarleglio
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Editor information

Editors and Affiliations

  1. Department of Surgical Sciences Division of Digestive Surgery, Catholic University, Rome, Italy

    Carlo Ratto  & Giovanni B. Doglietto  & 

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Sze, E.H.M., Ciarleglio, M. (2007). Obstetric Lesions: The Gynaecologist’s Point of View. In: Ratto, C., Doglietto, G.B., Lowry, A.C., Påhlman, L., Romano, G. (eds) Fecal Incontinence. Springer, Milano. https://doi.org/10.1007/978-88-470-0638-6_30

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  • DOI: https://doi.org/10.1007/978-88-470-0638-6_30

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0637-9

  • Online ISBN: 978-88-470-0638-6

  • eBook Packages: MedicineMedicine (R0)

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