3RD-DEGREE OBSTETRIC TEARS - OUTCOME AFTER PRIMARY REPAIR

Background Disruption of the anal sphincter occurs in 0.5 to 2.5% of w omen during delivery. Defects of the sphincter are major causes of fec al incontinence. More than 30% of women who suffer from third degree p erineal tears develop incontinence. We sought to determine the inciden ce of symptoms and injury to the anal sphincter among women who gave b irth during a 5 year period. We also investigated the sensitivity of m anometry and endosonography as well as the correlation of these two di agnostic modalities. Methods. Thirty-eight women were examined one to five years after delivery. We used a questionnaire to assess symptoms of anal incontinence. Anal manometry and endosonography were performed . Results. Twenty (57%) women had symptoms; most of them (34%) in the form of flatulence incontinence. The rest were incontinent of either l iquid or solid stools. Four of these women were re-operated. Seventeen percent of the women suffered from anal incontinence during sexual in tercourse. Only seven women had been in contact with a doctor regardin g these problems. Conclusion. The fact that 57% of the women that took part in this study reported complications, leads us to the conclusion that the primary repair of third degree anal sphincter tears is unsat isfactory. It is important to decide whether any changes in primary re pair may improve results in the future. Sexual dysfunction is also a c omplication of third degree obstetric rear with primary repair. It is important that the women who suffer from anal spincter tear, as well a s doctors, are given information about possible symptoms and the treat ment available.