Anal incontinence

The acquired form is most commonly associated with traumatic injury to the perineal region, including structural and functional damage to the pelvic floor following vaginal delivery. A key contributing factor is obstetric anal sphincter injury (OASI), which may be inadequately recognised or managed at the time of birth.

Diagnostic evaluation follows a structured algorithm. Endoanal ultrasound remains the gold standard for visualising sphincter integrity. However, transperineal 3D/4D ultrasound has emerged as a viable alternative, particularly within urogynecological practice, offering sufficient negative predictive value for assessing structural defects.

Functional assessment is complemented by high-resolution anorectal manometry (HRAM), while MR defecography is employed from a proctological perspective to exclude morphological causes of defecatory dysfunction. The severity of symptoms is further quantified using validated scoring systems such as the Wexner and St. Mark’s questionnaires. In selected cases, electromyographic evaluation of pudendal nerve terminal motor latency may be indicated.

Therapeutic strategies are guided by evidence-based recommendations issued by relevant professional societies. Management is tailored to the individual and may include conservative, surgical, or neuromodulatory interventions. The choice of treatment should be based on symptom severity and the extent to which the condition affects the patient’s quality of life.

In young women, anal incontinence secondary to OASI can be particularly debilitating. However, symptoms may be significantly ameliorated through precise and timely surgical repair.

This work focuses on the diagnostic and therapeutic approaches to anal incontinence in the context of obstetric anal sphincter injury. It aims to enhance interdisciplinary awareness among healthcare professionals. An instructional video demonstrating sphincter suturing on an animal model is included to support clinical education.

Link		Date	Availability [?]	Clinically sensitive [?]	Licence
Anal incontinence		11.9.2025	MEFANET user	–

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Courses

• Human anatomy II [Bi5121]
• Gynecology and Obstetrics [VLPG9X1]
• Surgical suturing [aVLSI071x]
• Surgery [VLCH091]
• Surgery II [MPCH0822]
• Gynaecology [BFGY051]
• Kinesiotherapy IV-2 - practice [MFKI1052c]
• Examination methods in physiotherapy in gynaecology and obstetrics - seminar [MFVM0711s]
• Nursing in Gynaecology I - lecture [BPZG0121]
• Nursing in gynaecology II - lecture [BPZG0322p]

Related contributions:

• Anal sphincter repair following obstetric anal sphincter injury (OASI)