anal sphincter injury at vaginal delivery - RePub - Erasmus

116 Pages·2011·1.74 MB·English

ANAL SPHINCTER INJURY AT VAGINAL DELIVERY:
RISK FACTORS AND LONG-TERM CLINICAL CONSEQUENCES
BESCHADIGING VAN DE ANALE SFINCTERS TUDENS DE VA GINALE BARING:
RISICOFACTOREN EN KLINISCHE GEVOLGEN OP LANGE TER'\UJN
CIP-DATA KONINKLIJKE BIBLIOTHEEK DEN HAAG
de Leeuw. Jan Willem
Anal sphincter injury at vaginal delivery:
risk factors and long-term clinical consequences I Jan Willem de Leeuw
Thesis Erasmus University Rotterdam-With ref. -With summary in Dutch.
ISBN: 90-90!5053-6
Subject headings: Anal sphincter. Delivery, Fecal incontinence
© Jan Willem de Leeuw. 2001.
All right reserved. No part of this book may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means. electronic. mechanical,
photocopying, recording. or otheiVIise. without the prior written permission of the
holder of the copyright
Cover photo: ""Milky way with black hole vortex··
© Digital /Corbis
Drawings in the thesis by the author
Financial support for publication of this thesis was generously provided by
Pharmacia & Upjohn BV. Schering Nederland BV. Medical Dynamics. Abbott BV.
Sigma Tau Ethifarma BV. Medtronic BV. Organon Nederland BV.
B-K Medical Benelux NV. and Johnson & Johnson Medical BV.
ANAL SPIDNCTER INJURY AT VAGINAL DELIVERY:
RISK FACTORS AND LONG-TERM CLINICAL CONSEQUENCES
BESCHADIGING VAl'! DE ANALE SFINCTERS TUDENS DE V AGINALE BARING:
RISICOFACTOREN EN KLINISCHE GEVOLGEN OP LANGE TERMIJN
PROEFSCHRIFT
TER VERKRIIGING VAN DE GRAAD VAN DOCTOR AAN DE
ERASMUS UNIVERSITEIT ROTTERDAM OP GEZAG VAN DE
RECTOR MAGI'"'FICUS
PROF. DR.IR. J.H. VAN BEMMEL
EN VOLGENS BESLUIT VAN HET COLLEGE VOOR PROMOTIES
DE OPENBARE VERDEDIGING ZAL PLAATSVINDEN OP
WOENSDAG 19 DECEMBER 2001 OM 13.45 UUR
DOOR
JAN WILLEM DELEEUW
GEBOREN TE ROSSUM
Promotiecommissie
Promotor Prof. dr. H.C.S. Wallenburg
Overige leden Prof. dr. Th.J.M. Helmerhorst
Prof. dr. C.G.M.I. Baeten
Prof. dr. E.J. Kuipers
Copromoter Dr. M.E. Vierhout
"There are in fact Mo things, science and opinion;
the former begets knowledge, the latter ignorance."
Hippocrates

CONTENTS
1. GENERAL INTRODUCTION 11
2. THE FEMALE ANAL CANAL: EMBRYOLOGY, ANATOMY,
AND ROLE IN FECAL CONTINENCE AND DEFECATION
2.1 Introduction 15
2.2 Embryology of the anal canal 15
2.3 Anatomy of the anal canal
2.3.1 General description 17
2.3.2 Epithelium 18
2.3.3 Arterial. venous and lymphatic supply. and innervation 19
2.3.4 Anal musculature 21
Internal anal sphincter 21
Conjoined longitudinal muscle 22
External anal sphincter 23
2.4 Physiology of Fecal Continence and Defecation 24
3. RISK FACTORS FOR ANAL SPIDNCTER INJURY AT VAGINAL
DELIVERY
3.1 Introduction 29
3.2 Methods 30
3.3 Results 32
3.4 Discussion 35
7
4. ANAL SPHINCTER INJURY AT VAGINAL DELIVERY: FUNCTIONAL
OUTCOME AND RISK FACTORS FOR FECAL INCONTTh'ENCE
4.1 Introduction 41
4.2 Methods 42
4.3 Results 43
4.4 Discussion 48
5 ANAL SPHINCTER INJURY AFTER VAGINAL DELIVERY:
RELATIONSHIP OF ANAL ENDOSONOGRAPHY AND MANOMETRY
WITH ANORECTAL COMPLAINTS
5.1 Introduction 53
5.2 Methods 54
5.3 Results 59
5.4 Discussion 63
6 GENERAL CONCLUSIONS AND RECOMMENDATIONS
6.1 Anatomy and physiology of the female anal canal 67
6.2 Risk factors for the occurrence of anal sphincter injury at delivery 70
6.3 Functional outcome and risk factors for the development 72
of fecal incontinence after anal sphincter injury at vaginal delivery
6.4 Relationship of anal endosonography and manometry with anorectal 76
complaints after anal sphincter injury at vaginal delivery
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SuMMARY 79
SAMENVATTING 85
REFERENCES 91
ACKNOWLEDGEMENTS 101
CURRICULUM VITAE 103
APPENDIX A POSTAL QUESTIONNAIRE (IN DUTCH) 105
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