Management of faecal incontinence following obstetric injury

Abstract

Third-degree tear occurs in association with less than 1 per cent of vaginal deliveries, but occult sphincter injury occurs at one-third of deliveries and may be significant in later life. Incontinence may result from sphincter damage or nerve injury, or both. Risk factors for these injuries can be identified. Clinical evaluation, anorectal physiology and endoanal ultrasonography allow accurate planning of subsequent surgery. Overlapping anterior anal sphincter repair provides symptomatic control of continence in 80 per cent of patients. Repair of an acute anal sphincter injury after a third-degree tear is controversial and a defined policy should be agreed between obstetric and colorectal teams.

Early Functional Results of Biofeedback and Its Impact on Quality of Life of Patients With Anal Incontinence

“…Biofeedback is an important therapeutic tool used in treatment of this condition, based on the training of the pelvic floor muscles with the use of visual and/ or sound stimulus in order to obtain a more appropriate response in active exercises of contraction and relaxation (7) . This technique has been regarded as first-line treatment for patients with mild to moderate incontinence.…”

Overlapping Repair in Patients with Anal Sphincter Injury

“…Fecal incontinence significantly affects a patient's life. Anal sphincter repair can reestablish continence and improve the quality of life for the patient [4][5][6] . Overlapping sphincter repair is defined as a repair procedure for anal sphincter injury due to obstetric trauma [4][5][6][7] .…”

“…Anal sphincter repair can reestablish continence and improve the quality of life for the patient [4][5][6] . Overlapping sphincter repair is defined as a repair procedure for anal sphincter injury due to obstetric trauma [4][5][6][7] . The operative technique was first described by Parks and McPartlin [7] in 1971 and subsequently was modified by Slade et al [5] nence; however, recent reports have stated that the outcome of overlapping sphincter repair in patients with obstetric injury is seldom perfect in the long term [8] .…”

Current Management of Fecal Incontinence

“…The most common cause of fecal incontinence is obstetric injury (Figure 3). 5 Changes in rectal sensation or rectal compliance can result in urgency, diminished capacity of the rectum, and loss of stool control. Conditions causing inflammation of the anorectum such as inflammatory bowel disease (ulcerative colitis and Crohn's disease) can result in urgency and incontinence.…”