Anal Incontinence in Chronic Total Perineal Rupture : A Case Report

Objective: Obstetric anal sphincter injury is a complication of vaginal delivery that, if inadequately managed, can lead to total perineal rupture and fecal incontinence, significantly impacting a patient's quality of life. This case report aims to describe the management of long-standing total perineal rupture in a patient with fecal incontinence. Method: A 37-year-old woman with a 1-year history of fecal incontinence and 15-year history of uncontrolled flatus following an unattended perineal tear during her first delivery was referred for evaluation. Physical examination and transperineal ultrasound revealed a perineal defect involving the external and internal anal sphincter. The patient was managed with sphincteroplasty and perineorrhaphy. Postoperative care included cleansing, catheterization, and medications, along with dietary modifications. Result: The patient’s Wexner score of 14 indicated moderate to severe fecal incontinence. After surgical management, the patient experienced improved control over bowel movements and enhanced quality of life. Conclusion: Vaginal lacerations can cause severe injuries to the perineal body and anal sphincters. Early identification and appropriate surgical intervention, such as sphincteroplasty and perineorrhaphy, are essential in improving outcomes and restoring quality of life in patients with obstetric anal sphincter injuries. Keywords: Obstetric anal sphincter injury, fecal incontinence, sphincteroplasty, perineorrhaphy, perineal rupture