A poor quality repair of a third or fourth degree tear during childbirth can lead to a lifetime of distressing symptoms. It can also lead to substantial compensation claims.
Guidelines on perineal tear repair
The Royal College of Obstetricians and Gynaecologists has issued clear guidelines as to the diagnosis and repair of severe anal sphincter injuries, otherwise known as third and fourth degree perineal tears.
It states the following:
- Repair should be by a trained clinician
- Repair should take place in an operating theatre
- Figure of eight sutures should be avoided
- A rectal examination should be carried out after the repair
- Anorectal mucosa (inner lining) repair should be carried out using continuous or interrupted technique
- IAS should be repaired separately
- A complete EAS repair should use an overlapping or end-to-end repair
Nonetheless, despite the degree of care and clarity expressed in these guidelines, incompetent and inadequate repairs continue to take place, leaving women with appalling side-effects and requiring further surgery.
Failure of perineal tear repairs
When the repair of a severe perineal tear fails, the woman can start to experience devastating and life-changing symptoms such as incontinence of wind; incontinence of faeces; pain and discomfort; leakage of wind or faeces via the vagina and repeated infections.
She may also find that she requires a colostomy bag due to her inability to control her bowel movements.
The social, financial and psychological impact of such symptoms can be dramatic.
Why do repairs fail?
Severe perineal tear repairs can fail for a number of reasons:
- The extent of the repair may be inadequate if an accurate diagnosis has not been made. The external anal sphincter may be repaired if it is thought that a woman has suffered a 3a tear but if, in fact, she has suffered a 3c tear or a 4th degree tear, this will not completely solve her problems
- An inappropriate method or material may have been used, leading the repair to break down and allowing symptoms to reappear
- An inexperienced repair may not resolve the damage fully or accurately
The RCOG guidelines observe that ‘inexperienced attempts at anal sphincter repair may contribute to maternal morbidity, especially subsequent anal incontinence.’
When it becomes apparent that surgery to repair an obstetric injury has failed, the woman may be offered further surgery to try to improve the situation.
Whilst this might be successful, research has shown that surgery to repair anal sphincter injuries some time after the birth may be less successful than had an effective repair been achieved at the time of the injury.
A failure to diagnose a tear accurately or at all or an inappropriate repair may be considered to be medically negligent.
If you are suffering the long-term effects of a substandard perineal tear repair, contact Glynns Solicitors to discuss your situation.
We are a specialist medical negligence legal practice and have supported numerous women in their claims for compensation for perineal injuries.