Abstract
Trauma sustained during childbirth is not always recognized, and damage to tissues and nerves may lead to long-term sequelae that can have a huge impact on the physical, social, and psychological well-being of women. However, even when trauma is recognized and repaired, the outcome may be suboptimal. Focused training in identification and appropriate repair is therefore mandatory. The two most important principles in primary repair of acute anal sphincter injuries are repair of the internal sphincter and restoration of the anal canal length. Subsequent vaginal delivery is not associated with adverse outcome in the majority of women.
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References
Mellgren A, Anzen B, Nilsson BY et al. Results of rectocele repair. A prospective study. Dis Colon Rectum 1995;38:7–13.
Shorvon PJ, McHugh S, Diamant NE et al. Defecography in normal volunteers: results and implications. Gut 1989;30:1737–1749.
Dietz HP, Steensma AB. The role of childbirth in the aetiology of rectocele. BJOG 2006;113:264–267.
Harkin R, Fitzpatrick M, O’Connell PR, O’Herlihy C. Anal sphincter disruption at vaginal delivery: is recurrence predictable?. Eur J Obstet Gynecol Reprod Biol 2003; 109:149–152.
Coats PM, Chan KK, Wilkins M, Beard RJ. A comparison between midline and mediolateral episiotomies. BJOG 1980;87:408–412.
Peleg D, Kennedy CM, Merrill D, Zlatnik FJ. Risk of repetition of a severe perineal laceration. Obstet Gynecol 1999;93:1021–1024.
Nordenstam J, Mellgren A, Altman D et al. Immediate or delayed repair of obstetric anal sphincter tears-a randomised controlled trial. BJOG 2008;115:857–865.
Ekeus C, Nilsson E, Gottvall K. Increasing incidence of anal sphincter tears among primiparas in Sweden: a population-based register study. Acta Obstet Gynecol Scand 2008;87:564–573.
Sultan AH, Thakar R. Third and fourth degree tears. In: Sultan AH, Thakar R, Fenner D (eds) Perineal and anal sphincter trauma. Springer-Verlag, London, 2007 pp 33–51.
Sultan AH, Kamm MA, Hudson CN et al. Anal sphincter disruption during vaginal delivery. N Engl J Med 1993;329: 1905–1911.
Allen RE, Hosker GL, Smith ARB, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. BJOG 1990;97:770–779.
Sultan A H. Obstetric perineal injury and anal incontinence. Clin Risk 1999;5:193–196.
Royal College of Obstetricians and Gynaecologists. Management of third and fourth degree perineal tears following vaginal delivery. Guideline No 29. London, RCOG Press, 2007.
Norton C, Christensen J, Butler U et al. Anal Incontinenc, 2 edn. Health Publication Ltd, Plymouth, 2005, pp 985–1044.
Sultan AH, Kettle C. Diagnosis of perineal trauma. In: Sultan AH, Thakar R, Fenner D (eds) Perineal and anal sphincter trauma. Springer-Verlag, London, 2007, pp13–19.
Royston GD. Repair of complete perineal laceration. Am J Obstet Gynecol 1930;19:185–195.
Kaltreider DF, Dixon DM. A study of 710 complete lacerations following central episiotomy. Southern Med J 1948;41:814–820.
Fulsher RW, Fearl CL. The third-degree laceration in modern obstetrics. Am J Obstet Gynecol 1955;69:786–793.
Cunningham CB, Pilkington JW. Complete perineotomy. Am J Obstet Gynecol 1955;70:1225–1231.
Sultan AH, Monga AK, Kumar D, Stanton SL. Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 1999;106:318–323.
Parks AG, McPartlin JF. Late repair of injuries of the anal sphincter. Proc R Soc Med 1971;64:1187–1189.
Walsh CJ, Mooney EF, Upton GJ, Motson RW. Incidence of third-degree perineal tears in labour and outcome after primary repair. Br J Surg 1996;83:218–221.
Sultan AH, Kamm MA. Faecal incontinence after childbirth. Br J Obstet Gynaecol 1997;104:979–982.
Cook TA, Mortensen NJ. Management of faecal incontinence following obstetric injury. Br J Surg 1998;85:293–299.
Kairaluoma MV, Raivio P, Aarnio MT, Kellokumpu IH. Immediate repair of obstetric anal sphincter rupture: mediumterm outcome of the overlap technique. Dis Colon Rectum 2004;47:1358–1363.
Sultan AH, Kamm MA, Hudson CN. Obstetric perineal tears: an audit of training. J Obstet Gynaecol 1995;15:19–23.
Andrews V, Thakar R, Sultan AH. Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:193–199.
Sultan AH, Thakar R. Lower genital tract and anal sphincter trauma. Best Pract Res Clin Obstet Gynaecol 2002;16:99–116.
Mahony R, Behan M, Daly L et al. Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injury. Am J Obstet Gynecol 2007;196:217. e1-5.
Vaccaro C, Clemons JL. Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:1503–1508.
Fernando R, Sultan AH, Kettle C et al. Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev 2006;(3):CD002866.
Fernando R, Sultan AH, Kettle C et al. A randomised trial of overlap versus end-to-end primary repair of the anal sphincter. Neurourol Urodyn 2004;23:411–412.
Fitzpatrick M, Behan M, O’Connell R, O’Herlihy C. A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 2000;183:1220–1224.
Williams A, Adams EJ, Tincello DG et al. How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial. BJOG 2006;113:201–207.
Molander P, Vayrynen T, Paavonen J et al. Outcome of primary repair of obstetric anal sphincter rupture using the overlap technique. Acta Obstet Gynecol Scand 2007;86: 1458–1462.
Lepisto A, Pinta T, Kylanpaa ML et al. Overlap technique improves results of primary surgery after obstetric anal sphincter tear. Dis Colon Rectum 2008;51:421–425.
Hool GR, Lieber ML, Church JM. Postoperative anal canal length predicts outcome in patients having sphincter repair for fecal incontinence. Dis Colon Rectum 1999;42:313–318.
Norderval S, Oian P, Revhaug A, Vonen B. Anal incontinence after obstetric sphincter tears: outcome of anatomic primary repairs. Dis Colon Rectum 2005;48:1055–1061.
Duggal N, Mercado C, Daniels K et al. Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial. Obstet Gynecol 2008;111:1268–1273.
Mahony R, Behan M, O’Herlihy C, O’Connell PR. Randomized, clinical trial of bowel confinement vs. laxative use after primary repair of a third-degree obstetric anal sphincter tear. Dis Colon Rectum 2004;47:12–17.
Eogan M, Daly L, Behan M et al. Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury. BJOG 2007;114:736–740.
Hedayati H, Parsons J, Crowther CA. Rectal analgesia for pain from perineal trauma following childbirth. Cochrane Database Syst Rev 2003;(3):CD003931.
Williams A, Lavender T, Richmond DH, Tincello DG. Women’s experiences after a third-degree obstetric anal sphincter tear: a qualitative study. Birth 2005;32: 129–136.
Fynes M, Donnelly V, Behan M et al. Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study [see comments]. Lancet 1999;18;354:983–986.
Scheer I, Thakar R, Sultan AH. Mode of delivery after previous obstetric anal sphincter injuries (OASIS) — a reappraisal? Int Urogynecol J Pelvic Floor Dysfunct 2009;20: 1095–1101.
Sultan AH, Stanton SL. Preserving the pelvic floor and perineum during childbirth— elective caesarean section?. BJOG 1996;103:731–734.
Andrews V, Thakar R, Sultan AH. Occult anal sphincter injuries — myth or reality?. BJOG 2006;113:195–200.
Groom KM, Paterson-Brown S. Can we improve on the diagnosis of third degree tears? Eur J Obstet Gynecol Reprod Biol 2002 10;101:19–21.
Fernando RJ, Sultan AH, Radley S et al. Management of obstetric anal sphincter injury: a systematic review & national practice survey. BMC Health Serv Res 2002;2:9.
McLennan MT, Melick CF, Clancy SL, Artal R. Episiotomy and perineal repair. An evaluation of resident education and experience. J Reprod Med 2002;47:1025–1030.
Siddighi S, Kleeman SD, Baggish MS et al. Effects of an educational workshop on performance of fourth-degree perineal laceration repair. Obstet Gynecol 2007;109: 289–294.
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Sultan, A.H., Thakar, R. (2010). Posterior Compartment Disorders and Management of Acute Anal Sphincter Trauma. In: Santoro, G.A., Wieczorek, A.P., Bartram, C.I. (eds) Pelvic Floor Disorders. Springer, Milano. https://doi.org/10.1007/978-88-470-1542-5_17
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DOI: https://doi.org/10.1007/978-88-470-1542-5_17
Publisher Name: Springer, Milano
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