Is there a role for the colorectal team in the management of acute severe third‐degree vaginal tears?

Abstract

The repair of sphincter injuries following vaginal delivery is often inadequate. The purpose of this study was to assess the short-term impact of involving a colorectal team in the management of patients with complicated acute severe third-degree tears. Over a 1-year period, four women (age 29-31 years) with acute severe third-degree tears extending into the anal canal or rectum were referred to the colorectal unit for repair of the injury. The internal anal sphincter (IAS) was identified and imbricated. A nerve stimulator was used to help identify the external anal sphincter (EAS) which was repaired using an overlapping technique. The women were reassessed at 3 months with anal manometry, pudendal nerve latencies and anal ultrasound. Further clinical assessment was performed at 1 year. Anal ultrasound revealed intact EAS repairs in all four women, although the IAS was thinned anteriorly in two. Resting anal pressures were slightly low (range 40-56 cmH2 O) but satisfactory squeeze pressures were obtained in all four women (range 78-100 cmH2 O). Pudendal nerve latencies were normal in three and prolonged on one side in the fourth woman. At 1 year, three were continent to solids, liquids and flatus, incontinence score=0, but one had occasional urgency. The fourth experienced occasional liquid seepage and frequent incontinence to flatus likely to represent IAS dysfunction (incontinence score=7). Satisfactory short-term results may be achieved following repair of acute severe third-degree tears and a nerve stimulator is important in identifying viable EAS to be used in repair. An integrated approach involving the experience of the colorectal team and anorectal physiology permits planning of future deliveries and may improve the long-term outcome.