title: [Practical issues in the management of third and fourth degree tears to minimise the incidence of faecal incontinence].
abstract: Faecal incontinence is underestimated in most epidemiological studies, probably because women may feel unable to discuss the symptoms they experience and avoid seeking medical advice. The most common cause of faecal incontinence in healthy women is an injury during a vaginal delivery. In this article we review the classification and terminology, as well as the risk factors, for third and fourth degree perineal tears. We also comment on the different suture techniques, the follow-up of women who sustain third and fourth degree tears and the advice given to those women regarding future pregnancies and mode of delivery. We highlight the importance of the endoanal ultrasound on the diagnosis of occult anal sphincter injury.
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital del Mar, Barcelona, España. Mfolch@imas.imim.es
authors.forename: Marina
authors.initials: M
authors.lastname: Folch
authors.forename: David
authors.initials: D
authors.lastname: Parés
authors.forename: Maite
authors.initials: M
authors.lastname: Castillo
authors.forename: Ramon
authors.initials: R
authors.lastname: Carreras
mesh_terms: D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007744:Obstetric Labor Complications / Q000601:surgery*; D011247:Pregnancy; D013536:Suture Techniques