CLINICAL CONSEQUENCES OF VAGINAL DELIVERY WITH MIDLINE EPISIOTOMY ANDANAL-SPHINCTER TEAR ON ANAL CONTINENCE IN PRIMIPARAE

Obstetric damage of the anorectal continence organ can lead to impaire d anal continence. To assess the effect of birth, either with or witho ut direct injury of the anal sphincter, 123 primiparae were studied. 4 1 patients with a midline episiotomy and 82 patients with an additiona l injury of the anal sphincter were assessed at a median of 21 weeks p ostpartum and compared with 18 healthy volunteers. Anorectal manometry as well as a standardized questionnaire were employed. Patients with an additional injury of the anal sphincter reported persistent flatus incontinence significantly more often (p = 0.0069) than patients with a midline episiotomy only. Incontinence of solid or liquid stool occur red only transiently. Compared to nulliparae in all primiparae a signi ficant shortening of anal canal and a decreased squeeze pressure were observed. In addition, a significantly reduced resting pressure was se en in patients with an anal sphincter injury. The rectoanal inhibitory reflex was absent significantly more often following anal sphincter t ear (p = 0.0023). Vaginal delivery, both with and without anal sphinct er injury, leads to early detectable changes in anorectal sphincter fu nction.