MANAGEMENT OF FECAL INCONTINENCE FOLLOWING OBSTETRIC INJURY

Background Faecal incontinence is common in women and the major aetiol ogical factor is childbirth. Increasing numbers of women with faecal i ncontinence are presenting to surgical clinics. Methods A literature r eview was performed on Medline database for English language publicati ons on obstetric injury. The incidence, presentation, assessment and t reatment of faecal incontinence following obstetric injury were evalua ted. Results and conclusions Third-degree tear occurs in association w ith less than 1 per cent of vaginal deliveries, but occult sphincter i njury occurs at one-third of deliveries and may be significant in late r life. Incontinence may result from sphincter damage or nerve injury, or both. Risk factors for these injuries can be identified. Clinical evaluation, anorectal physiology and endoanal ultrasonography allow ac curate planning of subsequent surgery. Overlapping anterior anal sphin cter repair provides symptomatic control of continence in 80 per cent of patients. Repair of an acute anal sphincter injury after a third-de gree tear is controversial and a defined policy should be agreed betwe en obstetric and colorectal teams.