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Methods of repair for obstetric anal sphincter injury

Fernando R, Sultan AH, Kettle C, Thakar R
Published Online: 
8 December 2013

Ways of repairing damage to the muscles of the back passage following tearing during a difficult vaginal birth.

The risk factors for obstetric anal sphincter injuries include a midline cut of the perineum (episiotomy) to facilitate the birth, forceps delivery and the baby’s back presenting posteriorly (occipito-posterior position). Most women give birth without any significant damage to their perineum or back passage. However, in about 1% to 4% of births, there is tearing and damage which extends to the back passage and the anal sphincter. This can cause considerable problems for some of these women in terms of pain, painful intercourse and faecal incontinence. For a few of these women, the incontinence can be very embarrassing and can impact significantly on their daily lives and relationships. This review of randomised controlled trials compared two different stitching techniques, one where the edges of the tissues were overlapped and the other where they were sewn end-to-end. There were 588 women in the six trials analysed. The trials were of moderate quality and differed in the participants, the outcome measures used and the points in time when they were measured. Only three trials with 156 women had 12-month follow-up data, when the overlap technique carried out as soon after childbirth as possible appeared to be better in terms of having faecal urgency and incontinence. Further research is needed to address women's views and experiences of surgery to prevent long-term problems.