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Background: Approximately 0·6-9 per cent of vaginal deliveries are complicated by third-degree tears. The precise impact of such injuries on future pelvic floor function remains unknown. The aim of this study was to define the extent of structural and physiological damage to the anal sphincter and to investigate anorectal function in women who sustained third-degree tears during vaginal delivery. Methods: Fifty-six women who sustained a third-degree tear were investigated prospectively. All patients had a primary repair of the anal sphincter complex, and were assessed by anorectal physiology and endoanal ultrasonography at a mean of 3·6 months. Symptoms were assessed by direct personal interview and also by a self-completed questionnaire. Results: Forty-four patients had a persistent anal sphincter defect on ultrasonography. The mean resting and squeeze anal canal pressures were significantly lower in patients with a combined defect than in those in whom the repair was intact (P = 0·036 and P = 0·005 respectively). At direct interview three patients volunteered current symptoms of faecal and/or urinary incontinence whereas 32 reported bothersome symptoms on the questionnaire (P < 0·001). Conclusion: The anatomical and physiological damage sustained during third-degree tears appears to be much greater than is generally appreciated. Primary repair does not provide lasting integrity. A self-administered questionnaire appears to be more accurate in defining the symptomatology. [ABSTRACT FROM AUTHOR]

Examines the psychological factors in the aetiology and treatment of urinary symptoms in women. Assessment of women attending a urodynamic clinic with the use of questionnaires; Cause of genuine stress incontinence; Effectiveness of bladder training in treating frequency.

Presents several correspondence on medicine. Occurrence of cyclophosphamide in hematological systemic lupus erythematosus; Method of weighing bed-bound patients; Diagnosis and management of diabetic autonomic neuropathy.

Examines the suprapubic catheterization technique of draining the bladder by catheter. Principles of insertion of catheters; Risk of implanting malignant cells in the fistulous track; Types of catheter.

Investigates the algorithmic method for assessing urinary incontinence in elderly women. Value of the techniques in the elderly; Risks from urodynamic investigation; Percentage rate of invasive investigations avoided by the method.

Examines reasons for delay in seeking treatment of urinary incontinence of women in Great Britain. Referral of patients to urodynamic clinics; Restrictions of urinary activities among patients; Association of the disease with age and marital status.

Examines the psychiatric aspects of urinary incontinence in women attending an outpatient urodynamic clinic in Great Britain. Types of psychiatric syndromes; Evaluation of the psychiatric morbidity; Occurrence of obstetric complications.

Investigates the transient autonomic and sensory neuropathy affecting the bladder in newly diagnosed insulin dependent diabetes mellitus. Occurrence of peripheral sensory and motor neuropathy in type 1 diabetes; Abnormalities of the somatic nervous system during impaired diabetic control; Changes of the pupillary responses of diabetics.