Non-Invasive Detection and Characterization of Anal Incontinence in the Parous Soldier

摘要

Disruption of the anal sphincters or injury to the sphincter innervation during childbirth is an important cause of anorectal incontinence among female soldiers. This study sought to determine the incidence of damage to the anal sphincter and the relation of injury and method of delivery to anorectal symptoms and function. Ninety active duty soldiers were studied at 24 weeks gestation and 12 weeks after delivery by comparing transanal ultrasonography, anal manometry, and pudendal nerve terminal motor latencies. Although only three percent of the subjects sustained clinically apparent injury to the anal sphincters during vaginal delivery 41% of the subjects demonstrated anal sphincter damage on their post-partum transanal ultrasonography. Twenty-one percent of the soldiers had anorectal symptoms after delivery and fifteen percent had at least occasional incontinence of flatus or liquid stool at 12 weeks post-partum. The incidence and severity of anorectal symptoms appear to diminish within a six-month time frame, but the structural damage to the anal sphincters appears to remain. The long-term effects of anal sphincter damage during childbirth remain to be determined.