Obstetric damage and faecal incontinence.

Abstract

Anal incontinence for gas or faeces affects up to 11% of adults, and occurs frequently in 2%. The commonest cause in healthy women is unrecognised damage to the anal sphincter during childbirth; 13% of women having their first vaginal delivery develop incontinence or urgency, and 30% have structural changes shown by anal endosonography. The commonest predisposing cause of damage is the use of forceps. When a third-degree tear occurs, 85% of women have persistent structural sphincter defects and 50% remain symptomatic despite primary repair after delivery. Structural damage associated with childbirth is more important than neurological factors. The characterisation of this sphincter damage ha..