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During childbirth it is highly likely a mother will experience a vaginal tear. These can be of varying severity, with 1st and 2nd degree tears being both highly regular and carrying little or no long-term damage. However, 3rd and 4th degree tears are more serious, and involve injury to the anal sphincter. This can result in problems such anal incontinence and uncontrollable flatus, often causing distress, embarrassment and an inability to continue with normal day to day living. Diagnosis of a Sphincter Injury. Injury to the anal sphincter as a result of childbirth should be detected by healthcare staff either during the delivery itself, or soon afterwards. To prevent the mother leaving hospital with unnoticed sphincter injuries there should be a full examination of the perineum and vagina - including a digital rectum examination - which should be performed after all vaginal deliveries. Sphincter injuries need to the treated as soon as possible to prevent any lasting damage occurring. This will usually involve a repair taking place within a few hours of delivery in an operating theatre. However, a mother who has suffered a sphincter injury which remains undetected may start to suffer from the following symptoms:- * Faecal incontinence; * Vaginal faecal loss; * Faecal seepage; * Uncontrollable flatus; * Faecal urgency. These symptoms can develop weeks, months or even years after childbirth, and will most likely worsen as time goes on due to the effects of age and the menopause. Treatment. If a mother experiences any of the above symptoms, medical advice should be sought immediately, as it is possible a sphincter injury has occurred without being properly treated. GPs should refer a woman suffering anal incontinence or pain after childbirth to a specialist gynaecologist or colorectal surgeon. Appropriate examinations should then be carried out to assess the problem, including a digital rectum examination, an anorectal physiology test and an endoanal ultrasound. If a sphincter injury is detected, it is likely secondary repair surgery will be needed. This will be performed under general anaesthetic by a colorectal surgeon, and depending on the extent of the damage will include repairs to the internal and external sphincter. Additional treatment may include: * Colostomy (in which a stoma is attached to the large intestine, allowing faeces to leave the body through an alternative channel); * Anal plugs; * Sacral nerve stimulation; * Biofeedback training; * Use of bulking agents and constipating agents; * Low fibre diet. As with all sphincter injuries - including those detected and treated soon after delivery - pelvic floor exercises should be performed, and all future births should be means of elective caesarean section. When Can Sphincter Damage During Childbirth Lead To A Medical Negligence Claim? Sphincter injuries during childbirth are most commonly the result of a vaginal tear. If your medical team had clear evidence that you were highly likely to tear, for reasons such as a larger than average baby or an instrumental delivery, but failed to take action to prevent the tear, you may be entitled to make a claim for compensation for medical negligence. This is also the case if a sphincter injury is not recognised immediately after delivery. To assess whether this is possible, we can offer you a free initial appraisal of your treatment, not only investigating the circumstances of the injury but also considering any other treatment that might be available for you.
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