Operating Room

In European countries, third- and fourth-degree per-ineal lacerations are frequently repaired under general or regional anesthesia in the operating room [1, 2, 7, 8,10,13,14,19-21, 23, 25-27, 29, 32]. The operating room provides superior lighting, appropriate equipment, and better exposure. In addition, general or regional anesthesia relaxes the patient and sphincter muscle tone. This allows the operator to retrieve the torn ends of the anal sphincter that had retracted into its fibrous capsule and perform the repair without tension. Investigators found that anal sphincter repair performed under such optimal conditions still has a 54-91% failure rate (Table 4) [10,18-21].

In contrast, anal sphincter tear in the United States is frequently repaired in the birthing room under local or regional anesthesia with less lighting and exposure. However, there are very little data evaluating the outcome of repairs performed in the birthing room. Investigators from the University of New Mexico were much more successful in repairing torn internal and external anal sphincters in the delivery room using either the end-to-end or the overlapping method than their European counterparts [30]. As previously noted, the New Mexico study had only 41 patients, and 15 (37%) did not return for follow-up. Whether anal sphincter repair performed in the operating room under regional or general anesthesia has a better outcome than those repaired in the birthing room needs to be objectively evaluated in a larger study.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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