Third degree obstetric anal sphincter tears

A tear involving the anal sphincter during vaginal delivery has great bearing on a woman's future continence. Whether it is a partial or complete laceration, periurethral tears and vaginal trauma are very serious and complicated injuries. Rupture of the external anal sphincter during childbirth also demands careful medical attention as it has the potential to be a devastating injury If unrecognised or inadequately repaired, these complications can lead to anal incontinence, urinary incontinence and, in the worst scenario, fistula formation. Immediate anal sphincter repair should be done to minimize the injuries. If the expertise is not available, the patient can be transferred to another center and a primary repair can be done. Primary repair ensures a woman has the best chance of making a full recovery. She may experience a few complications to begin with, especially with regard to faecal incontinence. However, as long as a competent repair is performed, it is likely a woman will regain normal function. If a sphincter injury is not detected at the time of the delivery, a woman will soon develop problems. This is likely to include faecal urgency and incontinence. Any woman who has recently given birth and who is experiencing such issues should undergo further medical investigation. If a third or fourth degree tear is subsequently diagnosed, an appropriate course of treatment should be devised to help a woman cope with her symptoms, which includes shincter repair 3Like

Incontinence after child birth

Young women with loss of control of passage of stools or gas or both need to be evaluated for the extent of damage to the anal sphincter after delivery. Specialized MRI and Ultrasound examination also helps. In case there is disruption of the anal sphincter in its entirety thus resulting in loss of control - the sphincter has to be repaired by doing surgery. The type of repair is very important for long time good results. If anal sphincter is thinned out, anal manometry and Pudendal Nerve Latency tests are done. Some special exercise regimes for anal musculature are prescribed. This is called Biofeedback exercises. Almost 90% and above will benefit from the surgery, biofeedback exercises or both.

Patients with loss of control over stools have a hope

Fecal incontinence defined as either the involuntary passage or the inability to control the passage of fecal matter or gas through the anus, affects up to 25% of childbearing women, often resulting from injury during birth. The severity of incontinence can range from unintentional elimination of flatus to leakage of liquid fecal matter or sometimes the complete evacuation of fecal contents. Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It’s especially likely to happen in a difficult delivery that uses forceps or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles weaken and the supporting structures in the pelvis become loose. Sometimes this is associated with stools being passed from the vaginal opening because of an abnormal passage being formed between the intestine and the vagina. Damage to the nerves that control the anal muscle or regulate rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur during childbirth or with severe and prolonged straining for stool. In our country, road traffic accidents are another major cause of damage to the sphincters that control the passage of stools. These injuries are usually associated with pelvic bone injuries, especially if the tire of the vehicle runs over the lower abdomen of the body. Patients usually have large wounds in the peri-anal region. Fortunately, effective treatment for fecal incontinence is available. Attempts at self-treatment are usually unsuccessful. Along with a physical exam, there are other tests, which can pinpoint the cause of the incontinence. The treatment of fecal incontinence varies and depends on the cause of the problem. Several different surgical procedures can treat fecal incontinence. Often these surgeries repair or replace sphincter muscles. In these surgeries lot of patients with a torn sphincter will require surgery, in which the small sphincter around the back passage is explored and the tear repaired. This sphincter being very small and indistinct, as well as damaged because of injury is difficult to locate at times and requires specialized skills. The abnormal passages are also excised at the same time with appropriate repair of the defects. In some instances, where the structure of the sphincter is intact but functioning is deranged, a diet change, treatment of constipation, bowel training and a specialized form of exercises call ‘anorectal biofeedback exercises’ results in marked improvements. In patients where all have failed, there are artificial sphincters, which can be implanted to give some relief from the problem. If not properly treated, many of these patients will end up having a permanent stoma on the abdominal wall. A permanent stoma is an alternate route created on the abdominal wall, from where the patient’s stools are collected in a bag. Others live a life with these events resulting in loss of self-esteem, social isolation and a diminished quality of life. Both the embarrassment and social stigma attached to this disorder, often delay presentation as well as treatment for several years. However, this problem is treatable with considerable success. Even patients with long standing fecal incontinence with permanent stomas should seek medical advice, as the present day modern surgical treatment may not have been available in the past.