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Perineal examination as a predictor of underlying external anal sphincter damage
Article first published online: 19 AUG 2005
DOI: 10.1111/j.1471-0528.1997.tb12058.x
Issue
1471-0528/asset/cover.gif?v=1&s=b4e1d96c46e18c61210d584b63c13ee375cf562b "BJOG: An International Journal of Obstetrics & Gynaecology")
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 104, Issue 9, pages 1009–1013, September 1997
Additional Information
How to Cite
Frudinger, A., Bartram, C. I., Spencer, J. A. D. and Kamm, M. A. (1997), Perineal examination as a predictor of underlying external anal sphincter damage. BJOG: An International Journal of Obstetrics & Gynaecology, 104: 1009–1013. doi: 10.1111/j.1471-0528.1997.tb12058.x
Publication History
- Issue published online: 19 AUG 2005
- Article first published online: 19 AUG 2005
- Received 12 February 1997 Accepted 11 June 1997
- Abstract
- Article
- References
- Cited By
Objective To assess the relation between perineal inspection and sphincter integrity in parous women.
Design Prospective observational study.
Setting District general hospital.
Population Fifty-seven consecutive parous women attending a gynaecology clinic for problems unrelated to the pelvic floor.
Methods A detailed history of bowel function and mode of delivery obtained; the perineum inspected to determine the presence and position of scarring, and anal endosonography performed.
Results In 19 women with an intact perineum on inspection, endosonography showed perineal scarring in five, with both perineal and sphincter scarring in three. Four had urge faecal incontinence. Three patients had a perineal tear only on inspection, but this group was too small for analysis and was discounted. Nine had an episiotomy scar only. Endosonography demonstrated perineal scarring in four, and combined perineal and sphincter scarring in two; one woman in this group had urge faecal incontinence. Twenty-six women had episiotomy and perineal tears on inspection. Endosonography revealed underlying perineal scarring in five women, with combined perineal and sphincter scarring in 14; six women in this group had urge faecal incontinence and one passive incontinence for flatus. Sonographically the scarring was anterior and circumferential rather than radial, and mostly left-sided, whereas on inspection episiotomy and perineal scarring were right sided.
Conclusions A normal perineum on clinical examination does not exclude underlying sphincter damage. The incidence of sphincter damage increases significantly when an episiotomy scar is associated with a perineal tear.