Dyskutowana częstość poporodowych uszkodzeń zwieraczy odbytu

*Iwona Sudoł-Szopińska¹, Małgorzata Kołodziejczak², Justyna Radkiewicz³

Streszczenie
Vaginal delivery is a well-known cause of anal incontinence. Several risk factors have been suggested to affect the anal canal muscles, such as: primiparity, high infant birth weight, episiotomy, prolonged first and second stage of labour, specially when epidural analgesia was performed, malpresentation – occipitoposterior position, and specially the use of forceps and vacuum.
For many years, it has been shown that the frequency of such defect is very high and reaches 40% of women. Only recently, in 2004 a new study presented data on obstetric anal sphincters defects which verified such high statistics from the past. Our own studies are in line with recent data and showed no defects in asymptomatic women and single cases of obstetric anal sphincters defects in women with fecal incontinency. Importance of anal endosonography was indicated in this paper as a main imaging method enabling diagnosis of obstetric anal sphincters defects, frequently asymptomatic and not coexisting with high-grade peritoneum rupture, as well as planning reconstructive surgery of anal sphincters, including those coexisting with ano- or recto-vaginal fistulas. Opinions on importance of screening primiparas, especially following forceps delivery and trauma of the peritoneum were presented, as well, in order to diagnose anal sphincters defects and to reduce their further, cumulative trauma in the course of next delivery or proctologic surgery.

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