Adapted from Anne Gulland’s interview with surgeon Michael Keighley published in BMJ 25 March 2017.
About one in ten first time mothers who give birth vaginally can develop some sort of anal incontinence. This can lead to soiling, passing wind when you’d rather not, and needing a toilet urgently.
Despite the number of women affected it is rarely talked about. Some women feel trapped in their homes and hide dirty sheets from their partners. Returning to work is a difficulty too.
If the matter has not resolved in a few months surgery is usually required. Even then, this tends to be a patch up job, as getting normal anal function back is difficult. A woman may be able to hold stool in for say three or four minutes after surgery compared to one minute before this. As the years go on however, anal function can deteriorate again, especially after the menopause.
A study is being done by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives to try to get women to hold back in the second stage of labour as the baby’s head is being delivered. Giving a bit more time for the perineum to stretch, rather than just pushing the baby out, can reduce anal tears from 8% to 3%.
If anal tears are detected immediately and repaired by an obstetrician at the time, the success rate is better for the woman. If the tears are left, more scar tissue develops, and this impairs the result of future surgery.
The name of the new charity is: masic.org.uk