Anal sphincters defects following forceps delivery. Part one: forceps and episiotomies as the risk factors for anal sphincters defects

Vaginal delivery is a well-known cause of anal incontinence. Several risk factors have been suggested to affect the anal canal muscles, such as: primiparity, high infant birth weight, episiotomy, prolonged first and second stage of labour specially when epidural analgesia was used, malpresentation-occipitoposterior position, and specially the use of forceps and vacuum. Many recent studies have shown that forceps delivery causes anal sphincters injury in more than 60%, and even 80% of women. However, new data indicate that this incidence may not be as high, as previously quoted. The first part of this paper discusses various clinical aspects of vaginal delivery complications, including their clinical appearance, reasons of anal incontinence following deliveries, especially with the use of forceps, as well as methods of treatment used in case of faecal incontinency. The second presents applications of endosonography, with its advantages and limitations in the diagnosis of anal incontinence was presented.