title: Management of obstetric anal sphincter injuries--a role for the colorectal surgeon.
abstract: OBJECTIVE
  To determine if surgical repair of third and fourth degree obstetric perineal tears by an experienced colorectal surgeon produces satisfactory functional results in the short and long term.
  
  
  METHODS
  Consecutive deliveries were studied prospectively over a 32-month period. All patients with suspected third or fourth degree tears were referred to the colorectal team. Following confirmation of the injury, patients underwent surgical repair using a standard overlapped technique according to an established protocol. The patients were reviewed 2 months later. Long-term continence was determined, by postal and telephone follow up, after a minimum of 3 years.
  
  
  RESULTS
  Fifty-nine sphincter injuries were identified and repaired by the colorectal team. Two months following repair 51 (86%) of patients had normal continence, four (7%) had urgency, and five (8%) had occasional incontinence of flatus. All patients with any degree of incontinence underwent endoanal ultrasound at which no sphincter defects were noted, and all improved symptomatically following pelvic floor physiotherapy. Long-term follow up data was obtained in 45 women. Thirty-nine (87%) had normal continence scores, 11 (24%) described urgency, but only three (7%) were often incontinent of liquid stool. Seven (15%) were occasionally incontinent of flatus.
  
  
  CONCLUSIONS
  Excellent short and long-term functional results were obtained in the repair of third and fourth degree tears when performed by experienced colorectal surgeons. Since the protocol was established, obstetricians in North Cheshire have adopted the double overlapped technique, and now manage the majority of these injuries themselves.
authors.affiliation: Department of Surgery, North Cheshire Hospitals NHS Trust, Warrington, CheshireUK. franmcnicol@btopenworld.com
authors.forename: F J
authors.initials: FJ
authors.lastname: McNicol
authors.forename: C A
authors.initials: CA
authors.lastname: Bruce
authors.forename: S
authors.initials: S
authors.lastname: Chaudhri
authors.forename: J
authors.initials: J
authors.lastname: Francombe
authors.forename: E
authors.initials: E
authors.lastname: Kozman
authors.forename: B A
authors.initials: BA
authors.lastname: Taylor
authors.forename: M J
authors.initials: MJ
authors.lastname: Tighe
mesh_terms: D001003:Anal Canal / Q000293:injuries* / Q000601:surgery*; D003107:Colorectal Surgery; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010502:Perineum / Q000293:injuries* / Q000601:surgery*; D010819:Physician's Role; D012017:Referral and Consultation