About 85% of women sustain some form of perineal trauma with childbirth but significant trauma with extension into the anal sphincter complex is fortunately rare and limited to <5% births in Australia. If there is a large tear with childbirth then it can involve the anal sphincter complex which is the muscle around the anus. Any damage to this structure can lead to incontinence of flatus and faeces. Most obstetricians are trained to repair 3rd or 4th degree tears as these are called immediately after birth. Primary surgical repair of the injury at the time of childbirth offers good outcomes with more than 80% women remaining asymptomatic at 3 months.
The most common risk factors are the first delivery, previous 3rd degree tear and use of forceps to deliver your baby.
A small percentage of women will develop symptoms like
- faecal urgency,
- faecal soiling or incontinence
- flatal or wind incontinence – which is quite a big bother to the post-partum young woman and can be quite embarrassing
When should you have these symptoms checked out?
If you remain symptomatic and experience faecal urgency and occasional incontinence more than 6 months after child birth then you should have these symptoms checked out. You may require an endoanal ultrasound and manometry to establish the integrity of the anal sphincter complex.
Pelvic floor dysfunction
Pelvic floor dysfunction is when you are not able to effectively control the bladder or the bowel with laxity of the vagina and muscles in your pelvis. It is usually a dysfunction of the structural support system.
There are many different treatments available for pelvic floor dysfunction, including conservative and surgical treatments. Pelvic physiotherapy and exercises with strengthening the pelvic floor is the first step, however sometimes surgical interventions can be very successful.
How do I organise an appointment?
Please call up to enquire regarding an appointment if you are worried about these symptoms. Dr Singh is part of the perineal clinic at Royal Women’s Hospital and offers regular perineal trauma workshop for trainees, midwives and obstetricians. She offers endo anal ultrasound and manometry through the perineal clinic and works closely in a multi-disciplinary set up with colorectal surgeons both at the Royal Women’s hospital and Eastern Health and in the private.