CLINICAL ARTICLE Manometric evaluation of anal sphincter function after vaginal and cesarean delivery Ercan Yilmaz, Tuncay Nas, Umit Korucuoglu ⁎ , Ismail Guler Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey Received 15 April 2008; received in revised form 12 June 2008; accepted 17 June 2008 Abstract Objective: To compare anal sphincter function following spontaneous vaginal delivery and cesarean delivery, and assess the association of perineal length and sphincter injury with each delivery mode. Method: Perineal length was measured and anal manometric measurements were performed in 120 primigravidas before and after delivery. Results: Mean values for maximum anal resting and squeeze pressures were significantly lower after delivery irrespective of the mode of delivery, but there was a positive correlation between postpartum maximum anal resting pressure and perineal length (r = 0.24, P b 0.01). Conclusion: Anal sphincter function was disturbed after both vaginal and cesarean delivery, a finding weakened by the fact that almost half of the cesareans were performed for cephalopelvic disproportion identified during labor. © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. KEYWORDS Anal manometry; Cesarean delivery; Perineal length; Spontaneous vaginal delivery 1. Introduction Fecal continence depends on the proper functioning of anal sphincters, a normal anal sensation, and a normal pelvic anatomy. As gas and feces reach the rectum, the rectoanal inhibitory reflex provoked by the distention causes the internal anal sphincter to relax. As a result, gas and feces, which are differentiated via sensory receptors in the anoderm, can proceed through the anal canal. Defecation is inhibited by the contraction of the internal and external anal sphincters, which are innervated by the pudendal nerve. Any disturbance in this mechanism leads to fecal incontinence [1]. Fecal incontinence is a significant problem that can lead to social isolation [2]. The prevalence of fecal incontinence has been reported between 0% and 4.5%, but may increase to around 10% among the elderly [3]. A prevalence as high as 30% has been reported among patients with geriatric and psychia- tric conditions and the problem seems more common among women [3]. Causes of fecal incontinence include surgery, anal trauma, rectal prolapse, fistula, radiotherapy, and congenital anomalies, and spinal cord injuries and meningomyelocele may lead to neurological fecal incontinence. The most common cause of fecal incontinence, however, is birth trauma [4]. Fecal incontinence is diagnosed following examination of the anal canal's muscle tone and consideration of any history of surgery or trauma related to the anal region. An ultrasound examination and a manometric evaluation are required for a ⁎ Corresponding author. Gazi Hastanesi, Besevler, Ankara, Turkey. Tel.: +90 312 202 5921; fax: +90 312 202 5950. E-mail address: korucu23@yahoo.com (U. Korucuoglu). 0020-7292/$ - see front matter © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2008.06.018 available at www.sciencedirect.com www.elsevier.com/locate/ijgo International Journal of Gynecology and Obstetrics (2008) 103, 162–165