A fourth degree tear should be diagnosed and treated shortly after the injury occurs.
Sadly, this level of care is not always achieved – normally because medical practitioners fail to make an accurate diagnosis.
This will be troubling for a patient, as it has been shown that properly conducted repairs lead to good results in approximately 60% of patients who sustained a fourth degree tear.
Thus on the balance of probabilities, if a fourth degree tear is adequately repaired, a patient will not develop any life-changing symptoms.
There may be a degree of urgency due to pudendal nerve damage, and some fragmentation of the external anal sphincter, but there will not be incontinence of faeces and flatus.
Treating a missed fourth degree tear
If a fourth degree was initially missed, it becomes much more likely that a woman will go on to experience problems. This will arise due to a defect in the internal and/or external anal sphincter.
But what treatment options are available once the injury is eventually diagnosed?
Unfortunately secondary repairs of the anal sphincter are rarely technically feasible. The evidence from the literature is that even if it is possible to repair the sphincter, functionally it will not make any difference.
Sacral neuromodulation is a type of implant that helps the majority of patients with incontinence, although it will rarely lead to control of flatus (wind).
If a patient’s problem relates to an internal anal sphincter defect then a trial of sacral nerve stimulation is a reasonable option. Nevertheless, the results are much less predictable than for external sphincter dysfunction.
Other treatments that have been tried for internal anal dysfunction include the injection of bulking agents which have met with variable results.
A more recent technique that is in use in America but not in the UK is the SECCA procedure. This uses a special probe to induce heat shock proteins which are said to thicken and improve the function of the internal anal sphincter. It is possible that this may be more available in the future.
There may be other innovations that may alter what treatment is available over the coming years. However, currently these are the best treatment options.
Compensation for your injuries
If you have suffered complications because your fourth degree tear was missed, you will be the victim of medical negligence. This means you will be entitled to pursue a claim for compensation. This can help you pay for any private treatment you may need.
To find out more, please get in touch with us today.