Fast Track

A rectal examination with digital palpation is always necessary to determine the extent of injury

Obstetric anal sphincter injury is best detected clinically immediately after delivery

Repair torn anal epithelium with interrupted Vicryl 3-0 sutures, with the knots tied in the anal lumen

Repair the internal and external anal sphincters separately

Avoid codeine-based analgesia because it can cause constipation and lead to excessive straining and disruption of the repair

Any woman who sustains anal sphincter injury should be examined by a senior obstetrician 6 to 8 weeks after delivery

There is no evidence that routine episiotomy prevents recurrent anal sphincter injury

Cesarean delivery is recommended for women who have some degree of anal sphincter compromise, even if their symptoms are controlled

If operative vaginal delivery is required, vacuum extraction is preferred to reduce the risk of anal sphincter trauma