Abstract
<h3>Introduction</h3> The incidence of detected third and fourth degree tears is about 2–4%, the risk being higher in first vaginal delivery, assisted deliveries and where there is an abnormal presentation. Many become incontinent. <h3>Method</h3> 81 women with faecal incontinence after childhood trauma were interviewed. <h3>Results</h3> First vaginal delivery: 68 (84%). Assisted delivery: 57 (70%) (Ventouse alone 11, forceps alone 23, both 23). Third degree tear: 52 (64%) (repaired 27, missed 25). Fourth degree tear: 27 (33%) (repaired 13, missed 14). Neuropathy: 25 (31%). Recto-vaginal fistula: 14 (17%). Episiotomy fistula: 10 (12%). Stoma: 16 (20%) (7 still present). Urinary Incontinence: 42 (52%). All had severe bowel incontinence. Sexual dysfunction was present in 77 (95%). Emotional consequences included: anxiety: 80 (99%), embarrassment: 78 (96%), loss of dignity: 68 (84%), loss of confidence: 68 (84%), feeling isolated: 43 (53%), confined to the house: 24 (30%), antidepressant medication: 31 (38%), anger: 23 (28%). <h3>Conclusion</h3> More emphasis should be placed on antenatal counselling, particularly amongst mothers pregnant for the first time. <h3>Disclosure of interest</h3> None Declared.
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