Cause Of Anal Incontinence Research Articles

Fecal incontinence 1,2

Fecal incontinence 1,2

Lower genital tract and anal sphincter trauma

Anal incontinence occurs more frequently in women but its incidence is grossly underestimated because of under-reporting. Obstetric trauma is a major cause of anal incontinence but it is only recently that attention has been focused on this subject. Episiotomy and choice of instrument at assisted delivery have been subjected to randomized trials but some issues, such as the benefit of episiotomy in instrumental delivery, have not been addressed. The management of acute anal sphincter rupture is inconsistent and, although studies report on the sub-optimal outcome, evidence-based guidelines are currently awaiting publication. Training in perineal anatomy and repair is poorly taught, and there is wide variation in classification of perineal tears. Consequently anal sphincter tears are being missed at delivery and/or inappropriately managed. This chapter aims to highlight these issues based on previous and current teaching and to recommend a protocol based on the best available evidence.

Anorektale Inkontinenz als Folge der vaginalen Geburt

Obstetric trauma is the most common cause of anal incontinence in women. Incontinence is usually for gas, but some women are incontinent of solid or liquid stool. Women are frequently too embarrassed by anal incontinence to raise the issue with a physician. Vaginal delivery can result in direct muscular injury to the anal sphincter and indirect neurologic injury to the pelvic floor. Anal endosonography has shown a 30% rate of occult sphincter defects in women after their first vaginal delivery. About a third of these women develop anal incontinence or urgency, but the long-term clinical significance of these findings is unclear. Routine mediolateral episiotomy does not protect against anal sphincter trauma and midline episiotomy is associated with an increased rate of sphincter tears. Overall, anal sphincter tears occur at 0.4% to 7% of deliveries. About 19% to 58% of these women are incontinent at 6 months and symptoms can persist in up to 30%. Subsequent vaginal deliveries after an anal sphincter tear 1 increase the risk of anal incontinence. Elective cesarean delivery should be discussed with women with a persistent sphincter defect or transient fecal incontinence. Cesarean delivery is not associated with clinically significant long-term pelvic floor morbidity. Methods to prevent perineal trauma during vaginal delivery include restricting episiotomy and using vacuum extraction instead of forceps delivery, Obstetricians should be aware of the prevalence of and risk factors for the development of fecal incontinence and ask patients specifically about urinary and anal incontinence.

The value of sphincter asymmetry index in anal incontinence.

We tested the value of the sphincter asymmetry index (SAI), an adjunct study of vectormanometry for detecting sphincter defects of difficult clinical diagnosis, in patients with anal incontinence referred for anal manometry. Patients were prospectively classified as having no previous anal trauma (group I, n = 13), those with possible trauma (including previous vaginal delivery and anorectal surgery unrelated to the onset of incontinence; group II, n = 53), and those with previous anal trauma directly related by the patient to the onset of symptoms (group III, n = 39). These were compared to 30 healthy volunteers. Clinical data were compiled to obtain an incontinence score, sphincter defect, mean and maximal pressures, functional anal canal length, and SAI for both resting and squeeze pressure profiles. SAI values for the control group were 7.2 +/- 2.3% and 5.8 +/- 2.4% for resting and squeeze pressures, respectively. Female controls had shorter anal canals (P = 0.0001) and higher SAI during squeeze (P < 0.005) than male controls. Incontinence scores were 6.1 +/- 3.1, 8.6 +/- 3.9, and 12.5 +/- 4.9, in groups I, II, and III, respectively (P < 0.001). Mean SAI values at rest were 10.3 +/- 4.9% in group I, 19.0 +/- 10.6% in group II, and 23.6 +/- 14.0% in group III (P < 0.001); corresponding values during squeeze were 8.6 +/- 5.3%, 13.9 +/- 7.9%, and 16.8 +/- 8.0% (P < 0.01). Pressure profiles both at rest and during squeeze were inversely correlated with SAI; therefore the accuracy of SAI was not affected in patients with severe incontinence. Incontinent patients with a previous history of sphincter trauma thus had more severe incontinence, both clinically and manometrically, and higher SAI values than patients without prior trauma. The analysis of the SAI is a valuable tool for determining a traumatic cause of anal incontinence.

Is occult sphincter defect the cause of anal incontinence after vaginal delivery?

Is occult sphincter defect the cause of anal incontinence after vaginal delivery?

Occult obstetric trauma and anal incontinence.

Obstetric trauma is by far the commonest cause of anal incontinence in women. Denervation and reinnervation of the pelvic floor and anal sphincter following vaginal delivery has been previously demonstrated. The advent of anal endosonography, however, has enabled the identification of occult anal sphincter defects following vaginal delivery. It is now possible to identify risk factors and change obstetric practice accordingly so as to minimize anorectal morbidity.