Anal sphincters insufficiency in obstetrics and gynecology

It is considered that a great majoraty of all damages to the anal sphincters is due to the delivery particularly to a difficult and prolonged labor and the use of obstetrical instruments. Although a number of sphincter damages is immediately repaired, some of them is missed or may appear as complication of a perineal suturing. Pressure exerted by fetus on the pelvic walls and musculo-fascial stretching leads also to damaging to anal sphincters nerve supply. The use of modern tools such as anal manometry, endosonography or myography enables detailed diagnosis of anatomical lesions of anal sphincters as well as defects of their innervation.
Moderate damages to the sphincters may be treated by biofeedback or other methods of physical training and musculation. The basis of good results of anal sphincters surgical reconstruction is a technique of “overlapping” with the use of scarred tissue for suture line reinforcement. A better their tensile strength can be achieved by adding a perineal body repair. In case of nerve supply impairment without any anatomical defects to the sphincters a permanent sacral nerve stimulation may be applied.