CLINICAL CONSEQUENCES OF ANAL-SPHINCTER RUPTURE DURING VAGINAL DELIVERY

BACKGROUND: Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mention ed. ln clinical practice, however, it is not uncommon to meet women wi th anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth. STUDY DESIGN: Fifty-one consecutive women with primarily s utured anal sphincter rupture and 31 women without anal sphincter rupt ure were prospectively studied after vaginal delivery, All were assess ed clinically at 3 days, 6 weeks, and 6 months after delivery, After 6 months, all women underwent anorectal manometry and answered a questi onnaire about incontinence, social function, and general health. RESUL TS: The overall incidence of sphincter rupture was 2.4 percent. Signif icantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture, The resting pressures did not differ between groups. Approximately 40 percent of the women in b oth groups had noted some fecal incontinence by 6 months postpartum, S ymptoms were significantly more severe in patients with sphincter rupt ure. CONCLUSIONS: Anal sphincter rupture was 2.4 times as common as re ported in Swedish birth statistics. The high incidence of fecal incont inence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture .