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Type: Thesis
Title: Anal sphincter injury due to childbirth
Author: Rieger, Nicholas Anthony
Issue Date: 1997
School/Discipline: Dept. of Surgery
Abstract: Faecal urgency and incontinence are conditions affecting all ages and both sexes, but are particularly common in women. Faecal urgency is defined as the sense of having to rush to the toilet i.e. not being able to defer defecation for any significant period of time. Faecal incontinence is defined as the inadvertent or uncontrolled passage of flatus or stool. Faecal urgency and incontinence can have major consequences on the quality of a person’s life, Social, recreational, occupational and sexual activities are affected. They may become housebound, be forced to use pads, napkins and deodorants to help compensate and hide their symptoms. It may be the deciding factor in placing an elderly person in nursing care. Obstetric practice has an enormous bearing on anal sphincter function. This is thought to be the leading cause of incontinence, and is particularly associated with the management of difficult labours. This thesis sets out to examine the effect of labour and delivery on the function of the anal sphincter. In primiparous women, who would be expected to have normal anal sphincter muscle morphology and neural innervation, the effect of labour and delivery on the pressures generated by the anal sphincter measured by anal manometry was examined. The incidence of injury to the anal sphincter muscle and innervation was ascertained using anal ultrasound and pudendal nerve terminal motor latency (PNTML). The effect that an injury had on the anal pressures was determined. The mode of delivery and other delivery details such as the babies head circumference, weight, length of labour, perineal tear and use of episiotomy were examined to determine what influence these variables had on the incidence of injury either to the anal sphincter muscle or innervation and anal pressures' Testing of anal sphincter function was repeated at 6 months to determine if any injury was reversible or persisted to this time. Finally the patients were asked if they had any symptomatic anal sphincter dysfunction that could be ascribed to a documented injury to the anal sphincter muscle or inneruation.
Advisor: Wattchow, David
Dissertation Note: Thesis (M.S.)--University of Adelaide, Dept. of Surgery, 1997
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