Anal sphincter injury during vaginal delivery – an argument for cesarean section on request?
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A. Faridi
Abstract
Aims: Fear of damage to the pelvic floor from vaginal delivery and long-term sequelae (urinary and anal incontinence) sometimes being cited as an indication for cesarean section on request. The aim of the present study was to compare the effects of vaginal delivery versus elective cesarean section on anal sphincter function.
Material and methods: We studied 71 consecutive women six weeks before delivery, 52 of them 4–6 weeks after delivery, and all patients with occult sphincter lesions 3months after delivery. A bowel function questionnaire was completed, and anal endosonography, manometry, and measurement of the pudendal-nerve terminal motor latency were performed.
Results: Forty-two (80,8 percent) patients were delivered vaginally, ten (19,2 percent) by elective cesarean section at term. Clinically recognized anal sphincter injuries occurred in 9.5 percent (4) of patients, two of them developed incontinence for gas. The overall incidence of anal incontinence after vaginal delivery was 4.8 percent. Occult sphincter defects were identified endosonographically in 19 percent (8) of women, there was no reported case of any anal incontinence 3 months after delivery. No woman delivered by cesarean section had altered anal continence or any significant change in anal pressures, rectal sensibility, and PNTML.
Conclusion: Severe sphincter tear is the single most important factor leading to anal incontinence in women, whereas occult sphincter defects are rarely associated with short-term sequelae, but may predispose to the development of anal incontinence later on in life. Elective cesarean section should be recommended for women at increased risk for anal incontinence.
Copyright © 2002 by Walter de Gruyter GmbH & Co. KG
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Articles in the same Issue
- Editorial
- The odds of delivering one, two or three extremely low birth weight (<1000 g) triplet infants: a study of 3288 sets
- Evaluation of a device for objective determination of cervical consistency: A pilot study of devices validity on uterine specimens obtained by total abdominal hysterectomy for benign uterine disease
- Clinical risk factors for deep venous thrombosis in pregnancy and the puerperium
- Waterbirth: water temperature and bathing time mother knows best!
- Anal sphincter injury during vaginal delivery – an argument for cesarean section on request?
- Doppler sonography of uterine arteries at 20–23 weeks: risk assessment of adverse pregnancy outcome by quantification of impedance and notch
- Cadmium concentration in maternal and cord blood and infant birth weight: a study on healthy non-smoking women
- The effects of oral carbohydrate administration on fetal acid base balance
- Labor induction and meconium: in vitro effects of oxytocin, dinoprostone and misoprostol on rat ileum relative to myometrium
- Catch-up growth in fetal malnourished term infants
- Role of surfactant inhibitors in amniotic fluid in respiratory distress syndrome
- Congenital tuberculosis proven by percutaneous liver biopsy: report of a case
- A case of peripartum cardiomyopathy with a transient increase of plasma interleukin-6 concentration occurred following mirror syndrome
- Bilateral cystic adenomatoid lung malformation type III – a rare differential diagnosis of pulmonary hypertension in neonates
- An unexpected case of primary pulmonary hypertension of the neonate (PPHN). Potential role of topical administration of enoxolone
- Urethral catheterization in neonates – how far is too far?
- Congress Calendar
