Pelvic floor disturbance after childbirth - Vaginal delivery damages the upper levels of sphincter innervation

Citation
T. Sato et al., Pelvic floor disturbance after childbirth - Vaginal delivery damages the upper levels of sphincter innervation, DIS COL REC, 44(8), 2001, pp. 1155-1161
Citations number
18
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
DISEASES OF THE COLON & RECTUM
ISSN journal
0012-3706 → ACNP
Volume
44
Issue
8
Year of publication
2001
Pages
1155 - 1161
Database
ISI
SICI code
0012-3706(200108)44:8<1155:PFDAC->2.0.ZU;2-0
Abstract
PURPOSE: Vaginal delivery disturbs pelvic floor innervation, which has prev iously been studied as a single mechanism. The effects of childbirth on inn ervation at different levels of the anal sphincter system were studied afte r childbirth. METHODS: Both anal manometry and motor latencies were measure d in 67 females. Twenty-nine females (30.8 +/- 4.4 years) were examined fou r days after vaginal delivery. Eleven of these 29 females were re-examined five months after vaginal delivery. Nineteen females (33.6 +/- 4.6 years) w ho were examined five to nine days after undergoing an elective cesarean se ction and 19 asymptomatic, nonpregnant females (26.8 +/- 6.9 years) served as controls. Motor latencies were bilaterally measured within the anal sphi ncter system at 5, 3.8, 2.6, and 1.5 cm from the perineal skin by using a c oncentric needle electrode after sacral magnetic stimulation. Means of the bilateral latencies were analyzed. RESULTS: In postpartum females who gave birth vaginally, motor latencies at 5 and 3.8 cm, although not those at 2.6 and 1.5 cm, from the perineal skin were significantly prolonged, and anal pressure monitored by maximum resting and squeeze pressures was significant ly decreased compared with that in control females. The decreased anal pres sure normalized spontaneously. The prolonged motor latencies at the tipper two levels of the anal sphincter system persisted in these females for five months after vaginal delivery. CONCLUSIONS: The disturbance of innervation of the upper anal sphincter system after vaginal delivery may last for a l ong time, whereas the decreased anal pressure normalizes in a short time. T he protracted disturbance of innervation of the tipper anal sphincter syste m may be associated with later development of fecal incontinence.