Obstetric pelvic floor and anal sphincter injuries

Abstract

Key content Vaginal delivery, especially the first, contributes to the development of pelvic organ prolapse, and urinary and anal incontinence. Although the effects of childbirth on the pelvic floor are commonly reported within 12 months of delivery, the peak presentation of symptoms occur some 2–3 decades later. Vaginal childbirth, advancing maternal age and increasing body mass index are the most consistent risk factors. Diagnosis of obstetric anal sphincter trauma can be improved by training and thereby minimising the risk of anal incontinence. Further research, using pelvic floor imaging, may improve our understanding of the nature of pelvic floor and anal sphincter injuries. Learning objectives To review the effect of childbirth on pelvic organ function. To identify and appropriately manage anal sphincter injuries following childbirth. Ethical issues There are inadequate long‐term data from well‐conducted longitudinal studies to make definitive recommendations in many aspects of pelvic organ dysfunction.