Perineal tear

Introduction Perineal III degree laceration or complete perineal laceration, including vaginal laceration, perineal laceration and anal sphincter laceration, severe rupture can extend to the rectal wall, causing stool and gas incontinence. The cause of the accident is due to improper handling during the delivery process, and occasional trauma. For the mother who has a narrow outlet at the back of the pillow, it is necessary to make a large side cut when the forceps are delivered. If necessary, double-sided incision can be done to protect the perineum. Due to the vigorous implementation of the new method, the birth attendant properly protects the perineum and greatly reduces the incidence of perineal III degree laceration. Occasionally occurred in large hospitals in the city.

Cause

In observing the labor process, it is important to correctly estimate the size of the fetus, understand the position of the fetus and the exposed area, and prevent the emergency. For the mother who has a narrow outlet at the back of the pillow, it is necessary to make a large side cut when the forceps are delivered. If necessary, double-sided incision can be done to protect the perineum. The perineum is cut in the middle, in the hands of the skilled person, there is a superior side; but when the operating technique is unskilled, the perineum is not well protected, the wound in the midline of the perineum may continue to tear backward, resulting in III degree. A laceration, this is worthy of attention.

an examination

Related inspection

Gynecological examination vaginal gynecological routine examination gynecological routine examination gynecological health checkup

Check the diagnosis: the perineum disappears when the examination is made, and the ends of the vagina and the rectum are connected. The skin behind the anus is radial wrinkles, and the sphincter is retracted to form small depressions on both sides of the anus. During anal examination, the patient is inwardly contracted to test the regulatory function of the sphincter. If the rectum is also torn, the rectal mucosa is red and turned outward.

Differential diagnosis

Different from the following diseases that can cause fecal incontinence:

1. Neurological disorders and injuries: Defecation is a reflex activity under the innervation of the visceral autonomic nerves and the brain. These nerves have dysfunction or damage that can cause incontinence, such as temporary fecal incontinence after stroke shock. If the thoracolumbar vertebral stenosis damage the spinal cord or spinal nerve can cause paraplegia and cause fecal incontinence, in addition, the rectal wall near the anal mucosa resection, the rectal wall, the sensory nerve defects, mental retardation, etc. can cause fecal incontinence.

2. Muscle dysfunction and damage: the anal retraction and defecation function are innervated by the innervation, the internal and external sphincter and levator ani muscles to maintain these muscle relaxation, reduced tension or cut off or form a large area of scars can cause anal incontinence, Anal incontinence can also be caused by a decrease in muscle relaxation tension caused by rectal prolapse and acne polyps. Older people or suffering from certain diseases can also cause muscle atrophic anal incontinence, anorectal abscess, anal rectal cancer and other surgical severing or resection of the sphincter can also cause anal incontinence, burns and burns chemical corrosion can also cause large an area of scar anal incontinence, Chronic diarrhea and anorectal cancer can also cause anal incontinence. During the examination, the perineum disappeared and the ends of the vagina and rectum communicated. The skin behind the anus is radial wrinkles, and the sphincter is retracted to form small depressions on both sides of the anus. During anal examination, the patient is inwardly contracted to test the regulatory function of the sphincter. If the rectum is also torn, the rectal mucosa is red and turned outward.

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