Anal-sphincter Disruption after Obstetric Fourth-degree Laceration-report of a Case

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A 31-year-old woman was admitted to the hospital because of soiling and anal pain. She had a normal delivery on the 3 rd of August 2000 and a mediolateral episiotomy was performed. Fourth-degree laceration was identified at delivery and a gynecologist performed the primary suture. Surgery was carried out on the 12th of March 2001 after recovery from inflammation at the tear site. Anal ultrasound examination revealed a defect of the anterior external sphincter muscle. The sphincter, levator ani, anal canal epithelium and vaginal mucosa were repaired. She has been well, with no evidence of recurrence, for 10 months. Eight months after surgery, she was able to recommence a normal sexual life both physically and psychologically. A manometric study performed 5 months after surgery revealed that maximum squeeze pressure had increased 2.5 fold. Success in treatment of patients with tears should be measured not only in terms of successful long-term closure but also in terms of the patient's satisfaction with postoperative incontinence and sexual life.