A prospective cohort study of 208 women with a clinical diagnosis of postpartum perianal trauma between 06/2008 and 02/2010 was followed. On endoanal sonography 75% (145) had anal sphincter trauma, some with ancillary involvement such as the transverse perineii (123) and puboanalis (52). The remaining 25% had ancillary muscle damage only, involving the puboanalis (20%) and the transverse perineii (7%).
Women reported evacuatory symptoms including constipation (15%), sensation of incomplete evacuation (24%), straining (17%) and anal digitation (2%). Constipation and straining pre-delivery predicted problems post-partum period in 18.26% (38) of women. With 39.5% (15/38) having constipation post pregnancy compared to only 15.3% (26/170) of women with normal bowels pre-pregnancy (p = 0.0007). Also 50% (19/38) had straining post delivery compared to 18% (30/170) of women with normal bowels pre-pregnancy (p < 0.0001). In women with no pre-pregnancy symptoms, evacuatory symptoms was found in 33% (3/9) of those with ancillary damage and 19% (6/32) in those without (in the absence of sphincter injury) though this was nonsignificant (p>0.05). Higher incontinence rates and lower squeeze pressures was associated with sphincter trauma (P=0.02) but not evacuatory disorders or ancillary trauma.
Results may be due to limitations of methodology and inadequate sample size. A larger study would be important in determining the cause of evacuatory symptoms postpartum as there is little research on the subject. It is also important that doctors are trained to differentiate ancillary from sphincter trauma which may serve to make the woman anxious and at risk of evacuatory difficulties.
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