Document Detail

Symptoms and anal sphincter morphology following primary repair of third-degree tears.
MedLine Citation:
PMID:  14648738     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Approximately 0.6-9 per cent of vaginal deliveries are complicated by third-degree tears. The precise impact of such injuries on future pelvic floor function remains unknown. The aim of this study was to define the extent of structural and physiological damage to the anal sphincter and to investigate anorectal function in women who sustained third-degree tears during vaginal delivery. METHODS: Fifty-six women who sustained a third-degree tear were investigated prospectively. All patients had a primary repair of the anal sphincter complex, and were assessed by anorectal physiology and endoanal ultrasonography at a mean of 3.6 months. Symptoms were assessed by direct personal interview and also by a self-completed questionnaire. RESULTS: Forty-four patients had a persistent anal sphincter defect on ultrasonography. The mean resting and squeeze anal canal pressures were significantly lower in patients with a combined defect than in those in whom the repair was intact (P = 0.036 and P = 0.005 respectively). At direct interview three patients volunteered current symptoms of faecal and/or urinary incontinence whereas 32 reported bothersome symptoms on the questionnaire (P < 0.001). CONCLUSION: The anatomical and physiological damage sustained during third-degree tears appears to be much greater than is generally appreciated. Primary repair does not provide lasting integrity. A self-administered questionnaire appears to be more accurate in defining the symptomatology.
K Davis; D Kumar; S L Stanton; R Thakar; M Fynes; J Bland
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  90     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-03     Completed Date:  2004-01-08     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1573-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Department of Colorectal Surgery, St George's Hospital, London, UK.
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MeSH Terms
Anal Canal / injuries*,  physiopathology,  surgery,  ultrasonography
Endosonography / methods
Fecal Incontinence / etiology
Obstetric Labor Complications / pathology*,  surgery
Pelvic Floor
Postoperative Complications / etiology
Urinary Incontinence / etiology

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