Obstetric anal sphincter injuries – management guidelines

Abstract

Gas and stool incontinence is a serious disability, which significantly impairs the patient’s quality of life in the personal, professional and social sphere. Although it is estimated that continence problems affect up to 15% of the adult population, the problem still seems to be epidemiologically underestimated. In women, obstetric trauma is the most common cause of incontinence, referred to as “the silent affliction” as the patients do not talk about it, and doctors do not actively ask patients about incontinence after delivery. Insufficient reimbursement of sphincter repair by the National Health Fund means that there is little interest in performing sphincter repair in surgical departments, while the difficulty of the surgery requiring extensive experience, as well as the risk of postoperative complications make these procedures unattractive for the private sector. Proper emergency treatment of postpartum sphincter damage prevents functional complications in the form of gas and faecal incontinence. Elective, distant reconstructions have a higher complication rate than emergency reconstructions, and therefore should be preceded by imaging and functional diagnosis. The paper discusses the problem of postpartum incontinence, presenting the diagnostic and therapeutic algorithms for emergency and elective sphincter repair.