In a recent issue of the American Journal of Obstetrics and Gynaecology, researchers reported that bowel-related complications were more common following fourth-degree tear repair compared with third-degree repair. Furthermore, women with fourth-degree tears were significantly more likely to have an increased rate of combined defects of the internal and external sphincters.
"Our study demonstrates that third- and fourth-degree lacerations should not be collectively grouped together as 'severe perineal lacerations' because the outcomes appear to be significantly different," said Catherine Nichols, M.D., assistant professor of obstetrics and gynaecology at VCU, and lead author of this study. "Regardless of the initial degree of the tear, the status of the anal sphincter complex postpartum is very predictive of the likelihood of having bowel problems," she said.
According to Nichols, common complaints among women following anal sphincter repair are incontinence of stool and fecal urgency. The overall reported rate of anal sphincter lacerations is approximately six percent to 20 percent, with higher rates documented following forceps or vacuum delivery, she said. Risk factors for anal sphincter damage include delivery with forceps or a vacuum, having your first baby or delivering a large baby.
Some long-term effects of this type of trauma may include chronic fecal incontinence, perineal pain, recto-vaginal fistulas and pain during sexual intercourse. Many patients who experience chronic bowel incontinence may not seek medical help because they find the nature of the problem embarrassing, which can have a toll on quality of life.
"It is interesting how few women are educated about potential bowel control problems after sustaining either a third- or fourth-degree tear," she said. "It is our obligation as obstetricians to fully inform our patients."
MEDICA.de; Source: VCU Medical Center