The treatment of fecal incontinence after traumatic vaginal delivery: overlapping sphincteroplasty, internal anal sphincter imbrication, levatorplasty, culdoplasty, and perineorrhaphy

Abstract

Objective: To assess the operative procedure used in the treatment of fecal incontinence after traumatic vaginal delivery and the functional outcome after surgery. Methods: Between 1995 and 1998, a prospective nonrandomized study was conducted on 22 patients, all of whom had complete fecal incontinence of gaseous, liquid, and solid stool. Preoperatively, all patients were found to have anterior rupture of the external anal sphincter after vaginal deliveries. All patients underwent overlapping sphincteroplasty, culdoplasty, levator ani plication, and perineorrhaphy. Results: Incontinence to gas was found in only one woman (6%). Liquid incontinence was reported in 3 of 22 patients (13.7%). One patient (6%) experienced incontinence to solid stool. A total of four patients (18.2%) suffered constipation, but in only three patients (17%) did the constipation persist after 1 month. Ninety-five percent of the patients had no incontinence to solid stool. The mean follow-up period was 20 months. Conclusion: Ninety-five percent of patients are continent to solid stool. A total of 82% of patients suffer no fecal incontinence and experience excellent functional status, maintaining Grade III and IV continence.