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1 results

  • Chapter 8 - Previous Third and Fourth Degree Tears

  • Edited by Swati Jha, Sheffield Teaching Hospital NHS Foundation Trust, Priya Madhuvrata, Sheffield Teaching Hospital NHS Foundation Trust
  • Book:
    Gynaecology for the Obstetrician
    Published online:
    14 July 2023
    Print publication:
    03 August 2023, pp 72-82

  • Summary

    Consequences of obstetric anal sphincter injuries (OASIs) such as anal incontinence can lead to long-term physical and psychological sequelae. As OASIs occur more frequently in nulliparous women, women will probably present in a subsequent pregnancy. A subsequent delivery can increase the risk of developing or deteriorating anal incontinence symptoms. Therefore, counselling and mode of delivery recommendations should occur in the antenatal period to allow women to make an informed choice about their subsequent delivery. Intrapartum, obstetric practice can be adapted by clinicians, taking into account modifiable risk factors associated with repeat OASIs. However, approaches to prevention of sequelae such as anal incontinence in the long term remains unclear. Conservative options such as pelvic floor muscle training should be encouraged and in cases of intractable symptoms, surgical options are available but these should usually be considered in women who have completed their family.