Perineal injury sustained during childbirth is a major aetiological factor in the development of perineal pain, sexual dysfunction, prolapse and disturbance in bowel and bladder function.
Preferential use of the vacuum extractor, restricting the use of episiotomy, repair of anal sphincter rupture by a trained doctor and selective caesarean section in these women can be beneficial in preventing complications.
More focused training of midwives and doctors in perineal and anal sphincter anatomy and repair is needed to minimize the morbidity associated with inadequate repair and missed tears.
Future research must address ways to predict and minimize severe perineal injury, and the management of subsequent pregnancies following anal sphincter injury.
Keywords: anal sphincter; childbirth; delivery; episiotomy; incontinence; perineum; third degree tears
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Ruwan J. Fernando
Ruwan J Fernando MS MD MRCOG Department of Urogynaecology, Ground Floor, Cambridge Wing, St Mary’s Hospital, Praed Street, London W2 1NY, UK
Obstetrics, Gynaecology &Reproductive Medicine