Objective: The purpose of this study was to compare outcomes after third-versus fourth-degree laceration repair. Study design: Fifty-six primiparous women who sustained a third-or fourth-degree tear were enrolled at delivery and demographic and obstetric data were collected. At 6 weeks’ postpartum, subjects completed a bowel function questionnaire and endoanal ultrasonography was performed. Fisher exact test and chi-square were used for statistical analysis. Results: Thirty-nine women with third-and 17 with fourth-degree tears were enrolled. Subjects with fourth-were more likely to report bowel symptoms (59% vs 28% , P = .03), and to demonstrate persistent combined defects of the internal (IAS) and external anal sphincter (EAS) (48% vs 8% , P = .002) than third-degree tears. Combined defects were associated with the highest risk of bowel symptoms (OR 18.7, 95% CI 3- 101, P <.001). Conclusion: Bowel symptoms were more common after fourth-than third-degree repair, and may be secondary to higher rates of combined defects of the IAS and EAS.
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