Anorektale Inkontinenz als Folge der vaginalen Geburt

Abstract

Obstetric trauma is the most common cause of anal incontinence in women. Incontinence is usually for gas, but some women are incontinent of solid or liquid stool. Women are frequently too embarrassed by anal incontinence to raise the issue with a physician. Vaginal delivery can result in direct muscular injury to the anal sphincter and indirect neurologic injury to the pelvic floor. Anal endosonography has shown a 30% rate of occult sphincter defects in women after their first vaginal delivery. About a third of these women develop anal incontinence or urgency, but the long-term clinical significance of these findings is unclear. Routine mediolateral episiotomy does not protect against anal sphincter trauma and midline episiotomy is associated with an increased rate of sphincter tears. Overall, anal sphincter tears occur at 0.4% to 7% of deliveries. About 19% to 58% of these women are incontinent at 6 months and symptoms can persist in up to 30%. Subsequent vaginal deliveries after an anal sphincter tear 1 increase the risk of anal incontinence. Elective cesarean delivery should be discussed with women with a persistent sphincter defect or transient fecal incontinence. Cesarean delivery is not associated with clinically significant long-term pelvic floor morbidity. Methods to prevent perineal trauma during vaginal delivery include restricting episiotomy and using vacuum extraction instead of forceps delivery, Obstetricians should be aware of the prevalence of and risk factors for the development of fecal incontinence and ask patients specifically about urinary and anal incontinence.