Is uncomplicated obstetric perineal damage a risk factor for anal incontinence? Evaluation by anorectal manometry

The proximity of the anorectal sphineter apparatus and the vagina is a risk factor for faecal incontinence in women. To stud!, the impact of the first delivery on anorectal continence, we evaluated 74 primiparae (41 women wit h midline episiotomy and 33 women with either intact perineum or Grade I te ar only) and compared them to a control group of 18 nulliparous women. All subjects were examined by anorectal manometry and asked to complete a stand ardized questionnaire. Fourteen women of the primiparae group (eight patien ts with episiotomy, six pats. with intact perineum) had experienced inconti nence of flatus, and 6 patients (8%, one pat. (3%) with intact perineum) ha d occasional incontinence of liquid or solid stool in the first weeks follo wing delivery. We detected amongst those women who underwent episiotomy a s ignificantly decreased maximum squeeze pressure and in women with an intact perineum a significantly decreased resting anal pressure. In all primipara e the anal canal length was significantly less when compared with control g roup. Even when the anal sphincter appears intact, the trauma of delivery c auses detectable changes in the results of anorectal manometry, indicating a need for evaluation of the continence status at postpartum examination.