Diagnosis and management of obstetric anal sphincter injury.
OBJECTIVE
The purpose of this review is to outline optimum practice in diagnosis and management of obstetric anal sphincter injury. The review focuses briefly on prevention of the problem before outlining diagnosis of sphincter injury as well as immediate and long-term management of patients who have sustained such injuries.


RESULTS
Increasing vigilance is vital in order that sphincter injury is not overlooked; immediate radiological assessment may play a role in diagnosis. Optimum anal sphincter repair should be followed by oral laxative administration to maintain sphincter integrity. Biofeedback physiotherapy and sacral nerve stimulation show great promise in treatment of persistent symptoms. Optimum mode of delivery in future pregnancies is not clearly defined, and decisions should be individualized.


CONCLUSIONS
Because obstetric injury to the anal sphincter mechanism cannot always be prevented, efforts must focus on limiting its occurrence, documenting its severity and providing optimum therapy to women who have sustained it. Management includes routine postnatal review of at-risk women and antenatal assessment in future pregnancies to limit deterioration in continence after future deliveries.
Eogan
Maeve
M
UCD School of Medicine and Medical Science, Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles St, Dublin 2, Ireland.
O'Herlihy
Colm
C
D001003:Anal Canal / Q000293:injuries*; D005242:Fecal Incontinence / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D009772:Obstetrical Forceps / Q000009:adverse effects; D010502:Perineum / Q000293:injuries; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology* / Q000601:surgery