Anorectal incontinence as a sequela of vaginal delivery

Citation
A. Faridi et al., Anorectal incontinence as a sequela of vaginal delivery, GEBURTSH FR, 61(8), 2001, pp. 559-568
Citations number
93
Language
TEDESCO
art.tipo
Review
Categorie Soggetti
Reproductive Medicine
Journal title
GEBURTSHILFE UND FRAUENHEILKUNDE
ISSN journal
0016-5751 → ACNP
Volume
61
Issue
8
Year of publication
2001
Pages
559 - 568
Database
ISI
SICI code
0016-5751(200108)61:8<559:AIAASO>2.0.ZU;2-F
Abstract
Obstetric trauma is the most common cause of anal incontinence in women. In continence is usually for gas, but some women are incontinent of solid or l iquid stool. Women are frequently too embarrassed by anal incontinence to r aise the issue with a physician. Vaginal delivery can result in direct musc ular injury to the anal sphincter and indirect neurologic injury to the pel vic floor. Anal endosonography has shown a 30% rate of occult sphincter def ects in women after their first vaginal delivery. About a third of these wo men develop anal incontinence or urgency, but the long-term clinical signif icance of these findings is unclear. Routine mediolateral episiotomy does n ot protect against anal sphincter trauma and midline episiotomy is associat ed with an increased rate of sphincter tears. Overall, anal sphincter tears occur at 0.4% to 7% of deliveries. About 19% to 58% of these women are inc ontinent at 6 months and symptoms can persist in up to 30%. Subsequent vagi nal deliveries after an anal sphincter tear increase the risk of anal incon tinence. Elective cesarean delivery should be discussed with women with a p ersistent sphincter defect or transient fecal incontinence. Cesarean delive ry is not associated with clinically significant long-term pelvic floor mor bidity. Methods to prevent perineal trauma during vaginal delivery include restricting episiotomy and using vacuum extraction instead of forceps deliv ery. Obstetricians should be aware of the prevalence of and risk factors fo r the development of fecal incontinence and ask patients specifically about urinary and anal incontinence.