Anale Sphinkterschäden nach vaginaler Geburt und deren Auswirkung auf die anale Kontinenzleistung
type: CreativeWork
description: Disturbance of anal continence is a well known problem after vaginal delivery. Anal incontinence is not restricted to patients with third- and forth- degree obstetric perineal ruptures. The introduction of anal endosonography led to the recognition of unsuspected defects in continent women thought to have an intact perineum by clinical examination. This fact has not escaped the attention of obstricians. Only few and incongruent data on the incidence and pathogenesis of postpartum incontinence are available. Therefore it was the aim of the present study to evaluate and characterize the effects of vaginal delivery on anal continence prospectively. On 72 unselected women anal vector manometry, endoanal ultrasound, measurement of the pudendal-nerve terminal motor latency (PNTML) and rectal sensibility was performed in the 32th week of pregnancy and after delivery. Continence was evaluated according to the Kelly-Holschneider-Score. Patients with occult anal sphincter defects were additionally followed-up additionally 12 weeks after delivery. To exclude any influence of pregnancy only, 10 patients with elective caesarian section served as controls. After delivery continence did not change significantly when compared with the pre-delivery evaluation. However, there was a significant reduction of postpartum anal squeeze and resting pressures in all patients. PNTML and rectal sensibility were not influenced by vaginal delivery. Additionally endosonography revealed occult lesions of the internal and external anal sphincter on 19% of women who clinically seemed to have an intact sphincter. It was not possible to find an influence between the different modes of delivery and the risk for lesions of the sphincter ani. Episiotomie and vaginal-operative delivery (forceps/ vacuum) increased the risc for obstretric tears and fecal incontinence. After caesarian section there were no changes of continence, anal pressures, rectal sensibility or PNTML. Apparent and occult sphincter tears…
abstract: Disturbance of anal continence is a well known problem after vaginal delivery. Anal incontinence is not restricted to patients with third- and forth- degree obstetric perineal ruptures. The introduction of anal endosonography led to the recognition of unsuspected defects in continent women thought to have an intact perineum by clinical examination. This fact has not escaped the attention of obstricians. Only few and incongruent data on the incidence and pathogenesis of postpartum incontinence are available. Therefore it was the aim of the present study to evaluate and characterize the effects of vaginal delivery on anal continence prospectively. On 72 unselected women anal vector manometry, endoanal ultrasound, measurement of the pudendal-nerve terminal motor latency (PNTML) and rectal sensibility was performed in the 32th week of pregnancy and after delivery. Continence was evaluated according to the Kelly-Holschneider-Score. Patients with occult anal sphincter defects were additionally followed-up additionally 12 weeks after delivery. To exclude any influence of pregnancy only, 10 patients with elective caesarian section served as controls. After delivery continence did not change significantly when compared with the pre-delivery evaluation. However, there was a significant reduction of postpartum anal squeeze and resting pressures in all patients. PNTML and rectal sensibility were not influenced by vaginal delivery. Additionally endosonography revealed occult lesions of the internal and external anal sphincter on 19% of women who clinically seemed to have an intact sphincter. It was not possible to find an influence between the different modes of delivery and the risk for lesions of the sphincter ani. Episiotomie and vaginal-operative delivery (forceps/ vacuum) increased the risc for obstretric tears and fecal incontinence. After caesarian section there were no changes of continence, anal pressures, rectal sensibility or PNTML. Apparent and occult sphincter tears…
author: Schelzig, Petra
language: ger
keywords: info:eu-repo/classification/ddc/610, Medizin, Inkontinenz, okkulte Sphinkterschäden
date published: 2004
date modified: 2026-07-30T19:43:19Z
provider: RWTH Aachen University
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Publikationsserver der RWTH Aachen University