It is now recognized that 35% of women undergoing their first vaginal delivery develop anal sphincter injury [10,11]. Approximately 10% will still have anal symptoms of urgency or incontinence at 3 months post-natal. Again, in the 6-year follow-up study by Glazener et al. , there was no improvement in this anal incontinence rate over time and at 6 years the faecal incontinence rate actually increased to 13%. The aetiology of this type of anal sphincter trauma is complex in the same way as the mechanisms that maintain continence are complex. Instrumental delivery is a recognized cause of trauma and randomized trials suggest that the use of the vacuum extractor is associated with less perineal trauma than forceps delivery [12,13]. In looking at the incidence of anal incontinence, forceps delivery gave a 32% incidence versus 16% for vacuum extraction. The incidence of third and fourth degree tears varies enormously from centre to centre suggesting the clinical ability to recognize this type of trauma may vary. In those women who have a recognized anal sphincter rupture, 37% continue to have anal incontinence despite primary sphincter repair .
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Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.