Obstetric fecal incontinence. Role of pelvic floor denervation and results of delayed sphincter repair.

During the last five years, 37 patients with fecal incontinence because of childbirth have been investigated. Ages varied from 22 to 62 years and duration of symptoms from 0.3 to 26 years. Anal manometry was performed in all patients and electromyography was performed in 24 patients. Thirty patients underwent delayed sphincter repair. In all patients, a dehiscence was found anteriorly, bridged by scar tissue. Continence was restored in 25 patients (83 percent). Electromyography was performed postoperatively in patients who remained incontinent and who demonstrated severe denervation. All these patients had undergone previous sphincter repair. In seven patients, there were no signs of obstetric injury. Electromyography demonstrated severe denervation, but sphincter mapping did not demonstrate muscle discontinuity. Continence improved in four patients within one year as a result of reinnervation demonstrated by electromyography. The authors conclude that fecal incontinence after childbirth may be due to either obstetric rupture or denervation. Both disorders may coexist. Delayed sphincter repair gives excellent results provided that denervation is not present. Preoperative assessment with electromyography is mandatory.

[Fecal incontinence following obstetrical injury; significance of damaged pelvic floor innervation and results of surgical treatment]. / Incontinentie voor faeces na obstetrisch letsel; betekenis van beschadigde bekkenbodeminnervatie en resultaten van chirurgische behandeling.

During the last 5 years 33 patients with faecal incontinence due to childbirth were investigated. Ages varied from 23 to 61 and duration of symptoms from 0.3 to 25 years. Anal manometry was performed in all patients and electromyography was performed in 21 cases. Twenty-seven patients underwent delayed sphincter repair. Continence was restored in 21 (81%). Post-operatively performed EMG in the patients who remained incontinent demonstrated severe denervation but sphincter mapping did not demonstrate muscle discontinuity. Continence improved in three patients within one year as results of reinnervation. Faecal incontinence after childbirth may be due to either obstetric rupture or denervation. Both disorders may coexist. Sphincter repair gives excellent results provided denervation is not present. Preoperative assessment by EMG is mandatory.