We continue our monthly appointment by revisiting the topic started last month: anal sphincter injuries from childbirth. As we discussed, vaginal delivery tears are a significant and potentially debilitating complication. They occur when the sphincter muscle is partially or completely torn and can be caused by various factors, such as a very long labor, the baby’s high birth weight, and the use of instruments like forceps or a vacuum extractor. These injuries can lead to numerous physical complications, including:
- Acute and persistent perineal pain, especially during movement or urination.
- Difficulty with bowel control (fecal incontinence and/or involuntary release of gas).
- Painful scarring.
- Sexual dysfunctions.
- Pain during intercourse (dyspareunia).
Psychological complications
The complications are not only physical but also deeply involve psychological aspects. Women who suffer anal sphincter injuries during childbirth may experience significant discomfort and embarrassment, especially when symptoms such as fecal incontinence or involuntary release of gas occur. These issues can negatively impact the quality of life, with significant emotional and social repercussions.
Postpartum anxiety and depression are widely documented in these cases. Women face not only the arrival of a new life but also complications that deeply affect their sense of self and their relationships. Many experience a reduction in self-esteem due to a negative perception of their body, and a strong fear of no longer being attractive to their partner. When anal sphincter injuries and their related complications are present, a vicious cycle may develop in which physical discomfort feeds psychological distress, making the recovery process more difficult.
For this reason, it is essential that postpartum support includes an appropriate psychological approach to help women deal with both the physical and emotional challenges. Multidisciplinary care, involving gynecologists, midwives, physical therapists, and psychologists, can make a big difference in the recovery process, helping to restore overall well-being, both physically and mentally.
Preventing injuries during childbirth
Preventing anal sphincter injuries during childbirth is a key focus for obstetric professionals. The traumatic consequences and anatomical injuries to the birth canal, caused by the passage of the fetus, have become a central issue in modern obstetrics. Professionals play a crucial role in this context, actively contributing to prevention. So, what preventive measures can be taken to avoid anal sphincter injuries during vaginal delivery?
- Teaching expectant mothers pushing and breathing techniques to use during labor.
- Performing pelvic floor strengthening exercises during pregnancy.
- Maintaining a healthy body weight during pregnancy can reduce the risk of birth-related complications.
- Episiotomy should be reserved only for strictly necessary cases, as it can increase the risk of severe tears.
- During the pushing phase of labor, the midwife can provide manual perineal support to reduce tension on the anal sphincter.
- Some birthing positions or water births can help reduce stress on the perineum.
Treatment of anal sphincter injuries
Management of anal sphincter injuries varies depending on the severity of the tear. Third and fourth-degree injuries require greater attention and early diagnosis of sphincter injuries for timely treatment. Treatment approaches include:
- Medications for pain management: analgesics and laxatives may be prescribed to relieve pain and prevent straining during bowel movements and/or to reduce the risk of suture dehiscence.
- Pelvic physiotherapy: after surgery, it is essential for the patient to follow rehabilitation with pelvic floor strengthening exercises to improve sphincter control.
- Proctological consultation: in the presence of fecal or gas incontinence, a more thorough evaluation with transanal ultrasound and anal manometry may be required.
- Surgical intervention: in more severe cases, with complex vaginal deliveries, immediate surgical repair may be necessary.
Anal sphincter injuries that may occur during childbirth are a significant complication; however, with early diagnosis and appropriate treatment, most women can restore optimal function and regain a good quality of life. During pregnancy, it is essential to be aware of this risk and well-informed. Relying on competent healthcare professionals, who can provide both preventive support and timely intervention in case of childbirth-related anal injuries, is equally crucial. Only then can effective management be ensured, minimizing the consequences.
The contents of this page are for informational purposes only and should in no way replace the advice, diagnosis, or treatment prescribed by your physician. Responses to the same treatment may vary from patient to patient. Always consult your doctor regarding any information related to diagnoses and treatments, and meticulously follow their instructions.
