Third-degree tears involve the muscular ring (anal sphincter
) that helps to control bowel movement while in fourth-degree tears, the perineal muscle, the anal sphincter
and/or rectum is also damaged.
The rate of primary obstetric anal sphincter
injury is about 18% in vaginal deliveries (6).
As for the second case, presenting with extremely sharp upper back pain followed by paraplegia and anal sphincter
impairment, we chose immediate surgical intervention with thoracic endovascular aortic repair (TEVAR), aiming at amelioration of the pressure gradient across the juxtaductal coarctation in the aorta, to ensure the safety and the completeness of following surgical decompression of the spinal epidural hematoma.
The inability to evaluate the anal sphincter
complex, secondary extensions of the fistula as well as relevant anatomic compartments and musculature stand as the major drawbacks of this technique.
VAC can also be defined as a sphincter-saving procedure since the anal sphincter
is left intact (3).
BoTox A has been successfully used to treat skeletal muscle spasm and high-tension diseases in adults and children, such as esophageal achalasia. Langer and Birnbaum first described transabdominal ultrasound localization and anal sphincter
injection of BoTox A in children with congenital megacolon causing intestinal obstruction. However, this treatment is technically challenging.
The most common cause of anal incontinence in women is obstetric anal sphincter
The resting anal canal pressure mainly reflects the internal anal sphincter
function, while the voluntary squeeze pressure predominantly reflects the external anal sphincter
Likewise, obstetric anal sphincter
injuries are associated with short and long-term sequelae, mainly anal incontinence, rectovaginal fistulas, wound dehiscence, and abscess formation, which affect physically and psychologically patients (11,16-18).
Anatomically, in women, the perineal body separates the anal canal from the urogenital diaphragm in the median plane where the deep bulbospongiosus and superficial transverse perineal muscles meet the external anal sphincter
Pelvic magnetic resonance imaging demonstrated a wide, solid appearing mass that involves a significant portion of the anal sphincter
. The mass extended upwards from the perirectal region of the anus, coursing around the rectum with an additional lobulation.
Traditional surgical procedures; manual anal dilatation or internal lateral sphincterotomy have been commonly used to reduce the hypertonia of the internal anal sphincter
but they carry risk of permanent impairment of anal continence.