During a vaginal delivery, it is not uncommon for a woman to sustain a perineal tear. The extent of damage will vary from person to person, although it is only third and fourth degree tears that involve the anal sphincter.
These injuries can be defined as follows:-
- Third degree tear: injury to the perineum involving the anal sphincter complex;
- Fourth degree tear: injury to the perineum involving the anal sphincter complex (external and internal anal sphincter) and anal epithelium.
- Both third and fourth degree tears must be diagnosed soon after delivery. This is because a repair must be performed without too much of a delay; otherwise the prospect of a full recovery becomes less likely.
Diagnosing obstetric sphincter damage
In order to diagnose a third or fourth degree tear, a medical professional must perform a vaginal and rectal examination. Informed consent should be obtained and adequate pain relief provided. There must be good exposure of the perineal injury and if this is not possible then the woman should be placed in the lithotomy position. Good lighting is also essential. Once these steps have been achieved, a medical professional should carry out a visual examination before proceeding to a vaginal examination to establish the full extent of the vaginal tear. Lastly, a rectal examination should be performed to exclude injury to the anorectal mucosa and anal sphincter.
Without a rectal examination, isolated tears such as a 'button hole' injury to the rectal mucosa can be missed. Furthermore, a third or fourth degree tear may be present beneath apparently intact perineal skin. Obstetric sphincter damage cannot, therefore, be excluded without a rectal examination.
Delay in diagnosing obstetric sphincter damage
If, however, obstetric sphincter damage is not diagnosed and repaired soon after delivery, a number of serious complications will arise. Most notably, a woman will develop bowel and bladder disturbances, with incontinence to faeces, flatus and urgency all being common side-effects of undiagnosed sphincter damage. This will obviously cause extreme upset and embarrassment for the individual concerned, whose lifestyle will often undergo significant alteration as a result of their continuing symptoms.
Furthermore, a delay in diagnosing obstetric sphincter damage will reduce the likelihood of a successful recovery. Although studies are still being carried out, experts generally agree that secondary repairs (ie. a repair performed a long time after the birth) have a poor prognosis in the long term. This means that even if treatment is provided, it is possible that a woman will not regain normal bowel function.
Does a delay amount to medical negligence?
If there is a delay in diagnosing obstetric sphincter damage, the standard of medical care provided could be deemed negligent. This will usually occur for one of two reasons: either, a rectal examination was not performed whatsoever, or a rectal examination was performed but a more minor tear diagnosed. If either of these things has happened to you and you have suffered from undiagnosed obstetric sphincter damage, you need to speak to a medical negligence solicitor about claiming compensation for the injuries you have endured.