A. Faridi, S. Willis, P. Schelzig, W. Siggelkow, V. Schumpelick, W. Rath
Anal sphincter injury during vaginal delivery – an argument for cesarean section on request?
Aims: Fear of damage to the pelvic floor from vaginal delivery
and long-term sequelae (urinary and anal incontinence)
sometimes being cited as an indication for cesarean
section on request. The aim of the present study was to
compare the effects of vaginal delivery versus elective
cesarean section on anal sphincter function.
Material and methods: We studied 71 consecutive
women six weeks before delivery, 52 of them 4–6 weeks
after delivery, and all patients with occult sphincter lesions
3months after delivery. A bowel function questionnaire
was completed, and anal endosonography, manometry,
and measurement of the pudendal-nerve terminal
motor latency were performed.
Results: Forty-two (80,8 percent) patients were delivered
vaginally, ten (19,2 percent) by elective cesarean
section at term. Clinically recognized anal sphincter injuries
occurred in 9.5 percent (4) of patients, two of them
developed incontinence for gas. The overall incidence of
anal incontinence after vaginal delivery was 4.8 percent.
Occult sphincter defects were identified endosonographically
in 19 percent (8) of women, there was no reported
case of any anal incontinence 3 months after delivery.
No woman delivered by cesarean section had
altered anal continence or any significant change in anal
pressures, rectal sensibility, and PNTML.
Conclusion: Severe sphincter tear is the single most important
factor leading to anal incontinence in women,
whereas occult sphincter defects are rarely associated
with short-term sequelae, but may predispose to the development
of anal incontinence later on in life. Elective
cesarean section should be recommended for women at
increased risk for anal incontinence.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 30, 09/2002
Pages: 379 - 387
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