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Primary sphincter repair is inadequate in most women with obstetric ruptures following vaginal delivery. Residual sphincter defects remain in most and around 50% remain incontinent. If there is a residual sphincter defect following the operation (as demonstrated by endoanal ultrasonography), then the procedure may be repeated. [4] [5]
The external anal sphincter (or sphincter ani externus) is an oval tube of skeletal muscle fibers. [1] Distally, it is adherent to the skin surrounding the margin of the anus. [2] It exhibits a resting state of tonical contraction [1] and also contracts during the bulbospongiosus reflex. [3] [4] [5] [6]
The muscle helps maintain continence of urine along with the internal urethral sphincter which is under control of the autonomic nervous system.The external sphincter muscle prevents urine leakage as the muscle is tonically contracted via somatic fibers that originate in Onuf's nucleus and pass through sacral spinal nerves S2-S4 then the pudendal nerve to synapse on the muscle.
The internal sphincter is a continuation of the detrusor muscle and is made of smooth muscle, therefore it is under involuntary or autonomic control. This is the primary muscle for prohibiting urination. The female or male external sphincter muscle of urethra (sphincter urethrae): located in the deep perineal pouch, at the bladder's distal ...
Chromic catgut sutures are now places from within outward, including levator muscle fascia, perineal body, Colle's fascia, bulbocavernosus muscles and levator ani. The sutures are pulled up under tension and tied. The retracted ends of external sphincter muscle are now brought closer to the anterior midline of the anus.
The sphincter is separated either by simply stretching or cutting. Cutting the muscle prevents spasm and temporarily weakens the muscles. Both methods help the underlying area to heal. Remove the fissure and any underlying scar tissue. Suture back the wound. [4]
Third-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, and anal sphincter are torn; third-degree tears may be further subdivided into three subcategories: [6] 3a: partial tear of the external anal sphincter involving less than 50% thickness; 3b: greater than 50% tear of the external anal sphincter; 3c: internal sphincter is torn
Tears can involve the perineal skin or extend to the muscles and the anal sphincter and anus. The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or a scalpel to make the baby's birth easier and prevent severe injuries that can be difficult to repair. The cut is repaired with stitches (sutures).