Anal sphincter function and integrity after primary repair of third-degree tear: uncontrolled prospective analysis.
BACKGROUND
The purpose of the present paper was to determine the anatomical integrity and functional effect of a tear to the anal sphincter in women after vaginal delivery.


METHODS
A prospective review of third- and fourth-degree vaginal tears over a 3 year period at Lyell McEwin and Queen Elizabeth Hospitals, Adelaide. Obstetric details were obtained from the records. All were counselled by a continence advisor and offered consultation with a colorectal surgeon. The integrity of the anal sphincter was assessed by endoanal ultrasound.


RESULTS
During the study period there were 6875 vaginal deliveries. There were 89 women (1.3%) who had a third- or fourth-degree tear. Fifty-one (57%) agreed to participate. Primiparity (67%), episiotomy (49%), forceps delivery (29%) and instrumental delivery were common in women sustaining a tear. Symptoms of anal incontinence (mild) or faecal urgency were described in 23 women (45%). Except for three women with an anovaginal fistula none required surgery for the management of faecal incontinence. A sphincter defect was seen in 27 women (53%) on endoanal ultrasound. The presence or absence of a sphincter defect was not significantly associated with symptoms but a trend was suggested (chi2=3.21; P=0.07).


CONCLUSIONS
Third-degree tear after vaginal delivery was a significant intrapartum event, yet associated only with minimal symptoms (excluding patients with anovaginal fistula) even in the presence of a sphincter defect on anal ultrasound.
Rieger
Nicholas
N
University Department of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, South Australia, Australia. nrieger@medicine.adelaide.edu.au
Perera
Shevy
S
Stephens
Jacque
J
Coates
Donna
D
Po
Darren
D
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D007744:Obstetric Labor Complications / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D013536:Suture Techniques; D015599:Trauma Severity Indices; D016896:Treatment Outcome