Obstetric anal sphincter injuries: an underestimated problem

The assessment of the presence and extent of anal sphincter injuries following obstetric injury is often inaccurate due to inadequate diagnostic practices.

However, an accurate diagnosis of post-delivery sphincter injuries is crucial to prevent or reduce the risk of bowel incontinence.

Birth trauma and subsequent obstetric anal sphincter injuries are in fact the prevalent risk factor for bowel incontinence in women.

Obstetric anal sphincter injuries: the importance of early diagnosis

For this reason, early detection of possible post-delivery sphincter injuries is crucial in preventing or reducing the onset of bowel incontinence problems

This evaluation should be carried out thoroughly and fully between 1 and 6 months after giving birth.

Any vaginal birth can in fact cause occult anal sphincter tears that can only be identified and correctly diagnosed through specific instrumental examinations.

These examinations must include a complete assessment of sphincter damage from both a functional and morphological point of view.

Functional diagnosis of sphincter injuries from childbirth: Anorectal Manometry

Anorectal manometry is the fundamental examination to assess the functionality of the sphincter complex.

Thanks to this examination, it is possible to identify dysfunctions of the sphincter system during both muscle contraction and relaxation. It is also possible to assess rectal sensitivity and sphincter muscle contraction reflexes.

Anorectal manometry can therefore:

• show functional disorders of the sphincter complex
• identify damage to the internal and external anal sphincter
• monitor the results of biofeedback
• show the absence of contraction reflexes
• plan the management of the patient after an anal sphincter injury

For these reasons, anorectal manometry is an essential test in all clinically evident or suspected cases of bowel incontinence.

THD^® Anopress is a state-of-the-art portable solution for performing and interpreting clinical anorectal manometry which overcomes many of the limitations associated with traditional anal manometry. To find out more, click here.

Morphological diagnosis of sphincter tears from childbirth: Endoanal Ultrasonography (EAUS)

Endoanal ultrasonography (EAUS) makes it possible to assess the morphology of the sphincter complex and determine the presence and extent of any sphincter lesions.

The EAUS examination is the gold standard for assessing anal sphincter anatomy and, together with anorectal manometry, is essential for the accurate diagnosis of obstetric anal sphincter injuries.

Endoanal ultrasonography allows the specialist to see the pelvic floor and sphincter muscles to diagnose the following obstetric injuries:

• lacerations of the external anal sphincter
• lacerations of the internal anal sphincter

During the evaluation of such injuries, the EAUS examination allows the length and depth of the muscle involved to be identified, making the diagnosis even more precise.

The THD^® EAUS Probe ultrasound probe allows viewing of the pelvic floor and sphincter muscles, enabling anatomical and, together with anal manometry, functional evaluations that are essential for treating obstetric anal sphincter injuries. To find out more, click here.

The THD^® EAUS Probe is associated with THD^® Procto Software on two different platforms: THD^® HRStation and THD^® ProctoMobile.

THD^® Procto Software is a CE-marked medical device certified by TUV Rheinland.

THD^® ProctoMobile: the complete diagnostic system for the advanced assessment of obstetric anal sphincter injuries.

THD^® ProctoMobile is the integrated, portable diagnostic system that allows anorectal manometry and 360° EAUS to be carried out conveniently and quickly with a single instrument.

Its size allows both examinations to be carried out in smaller practices or during home consultations. THD^® ProctoMobile is ready to use and does not require calibration of manometer or ultrasonic probes.

This innovative portable diagnostic system also allows the specialist to interpret diagnostic test data in real time at the very first consultation.

To find out more advantages of THD^® ProctoMobile, click here.