{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T16:22:05Z","timestamp":1788625325861,"version":"build-2803163510"},"reference-count":27,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1996,7]]},"abstract":"<jats:p>BACKGROUND: Recently interest in idiopathic (neurogenic) faecal incontinence has swung from denervation of the external anal sphincter to the internal sphincter. AIMS: To evaluate the effects of vaginal delivery on the internal sphincter. SUBJECTS: 1372 mothers were studied antenatally and 1202 were accepted into the study. METHODS: Sphincter pressures were measured antenatally, in the early postnatal period, and six to 10 weeks later in selected patients. RESULTS: 755 of 1202 subjects assessed antenatally were primiparous women and 447 multiparous women. Some 320 previous spontaneous vaginal deliveries (SVD) (mean 59 mm Hg) and 67 previous forceps deliveries (mean 58 mm Hg) had lower resting pressures than 755 primiparous women (mean 66 mm Hg) (p &lt; 0.01). A total of 493 subjects were reassessed postnatally. There were 372 SVDs, 47 vacuum extractions, 20 forceps, and 54 caesarean deliveries. All vaginal deliveries but not caesarean sections dropped their resting anal pressures from antenatal values (p &lt; 0.001). Some 227 first SVDs had a much greater fall than 145 subsequent SVDs. In 162 subjects who had undergone their first vaginal delivery and who were followed up there was some recovery but the resting pressures were still lowered at six to 10 weeks post partum. CONCLUSIONS: The first vaginal delivery causes a permanent lowering of resting anal pressures. The possible reasons for this are discussed.<\/jats:p>","DOI":"10.1136\/gut.39.1.120","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"120-124","source":"Crossref","is-referenced-by-count":31,"title":["Disturbed anal sphincter function following vaginal delivery."],"prefix":"10.1136","volume":"39","author":[{"given":"J M","family":"Wynne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J L","family":"Myles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Sapsford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R E","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Hattam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S E","family":"Cantamessa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1996,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1056\/NEJM199312233292601","article-title":"Anal-sphincter disruption during vaginal delivery","volume":"329","author":"Sultan, A.H.; Kamm, M.A.; Hudson, C.N.; Thomas, J.M.; Bartram, C.I.","year":"1993","unstructured":"Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N EnglJ Med 1993; 329: 1905-11.","journal-title":"N EnglJ Med"},{"key":"ref_2","first-page":"20","article-title":"Risk factors in childbirth causing damage to the pelvic floor innervation","volume":"1","author":"Snooks, S.J.; Swash, M.; Henry, M.M.; Setchell, M.","year":"1986","unstructured":"Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int3ColorectDis 1986; 1: 20-4."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1111\/j.1471-0528.1990.tb02570.x","article-title":"Pelvic floor damage and childbirth: a neurophysiology study","volume":"97","author":"Allen, R.E.; Hosker, G.L.; Smith, A.R.B.; Warrell, D.W.","year":"1990","unstructured":"Allen RE, Hosker GL, Smith ARB, Warrell DW. Pelvic floor damage and childbirth: a neurophysiology study. 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BrJ' Obstet Gynaecol 1994; 101: 22-8.","journal-title":"Obstet Gynaecol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1136\/gut.18.8.656","article-title":"Sphincter denervation in anorectal incontinence and rectal prolapse","volume":"18","author":"Parkes, A.G.; Swash, M.; Urich, H.","year":"1977","unstructured":"Parkes AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977; 18: 656-65.","journal-title":"Gut"},{"key":"ref_7","first-page":"614","article-title":"Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence","volume-title":"BrJ7 Surg","volume":"71","author":"Kiff, E.S.; Swash, M.","year":"1984","unstructured":"Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. BrJ7 Surg 1984; 71: 614-6."},{"key":"ref_8","first-page":"24","article-title":"The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study","volume-title":"Br3J Obstet Gynaecol","volume":"96","author":"Smith, A.R.B.; Hosker, G.L.; Warrell, D.W.","year":"1989","unstructured":"Smith ARB, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br3J Obstet Gynaecol 1989; 96: 24-8."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/0016-5085(88)90175-8","article-title":"Internal anal sphincter in neurogenic fecal incontinence","volume":"95","author":"Lubowski, D.Z.; Nicholls, R.J.; Burleigh, D.E.; Swash, M.","year":"1988","unstructured":"Lubowski DZ, Nicholls RJ, Burleigh DE, Swash M. Internal anal sphincter in neurogenic fecal incontinence. 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Gut 1975; 16: 482-9.","journal-title":"Gut"},{"key":"ref_12","article-title":"Pelvic floor denervation: is it reversible?","author":"Myles, J.L.","year":"1991","unstructured":"Myles JL. Pelvic floor denervation: is it reversible? [Thesis]. Queensland: University of Queensland, 1991."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/BF02251969","article-title":"Normal variation in anorectal manometry","volume":"35","author":"Cali, R.L.; Blatchford, G.J.; Perry, R.E.; Pitsch, R.M.; Thorson, A.G.; Christensen, M.A.","year":"1992","unstructured":"Cali RL, Blatchford GJ, Perry RE, Pitsch RM, Thorson AG, Christensen MA. Normal variation in anorectal manometry. 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Br3J Surg 1989; 76: 748-51."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/BF02156270","article-title":"Rectal mucosal electrosensory testing - evidence for a rectal sensory neuropathy in idiopathic constipation","volume":"33","author":"Kamm, M.A.; Leonnard-Jones, J.E.","year":"1990","unstructured":"Kamm MA, Leonnard-Jones JE. Rectal mucosal electrosensory testing - evidence for a rectal sensory neuropathy in idiopathic constipation. Dis Colon Rectum 1990; 33: 419-23.","journal-title":"Dis Colon Rectum"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1136\/gut.17.4.306","article-title":"Influence of autonomic nerves on the intemal sphincter in man","volume":"17","author":"Frenckner, B.; Ihre, T.","year":"1976","unstructured":"Frenckner B, Ihre T. Influence of autonomic nerves on the intemal sphincter in man. Gut 1976; 17: 306-12.","journal-title":"Gut"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/BF02048375","article-title":"Relationship between parity and anal manometry","volume":"36","author":"Sultan, A.H.; Kamm, M.A.","year":"1993","unstructured":"Sultan AH, Kamm MA. Relationship between parity and anal manometry. Dis Colon Rectum 1993; 36: 783.","journal-title":"Dis Colon Rectum"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/BF02050212","article-title":"Reliability of anal pressure measurements","volume":"34","author":"Eckhardt, V.F.; Elmer, T.","year":"1991","unstructured":"Eckhardt VF, Elmer T. Reliability of anal pressure measurements. Dis Colon Rectum 1991; 34: 72-7.","journal-title":"Dis Colon Rectum"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/BF01645312","article-title":"Sympathetic nervous influence on the internal anal sphincter and rectum in man","volume":"3","author":"Carlstedt, A.; Nordgren, S.; Fasth, S.; Appelgren, L.; Hulten, L.","year":"1988","unstructured":"Carlstedt A, Nordgren S, Fasth S, Appelgren L, Hulten L. Sympathetic nervous influence on the internal anal sphincter and rectum in man. Int J Colorect Dis 1988; 3: 90-5.","journal-title":"Int J Colorect Dis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/0165-1838(84)90019-5","article-title":"Role of vesical afferent nerve fibres involved in the control of internal anal sphincter motility","volume":"10","author":"Bouvier, M.; Grimaud, J.C.; Salducci, J.; Gonella, J.","year":"1984","unstructured":"Bouvier M, Grimaud JC, Salducci J, Gonella J. 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Aust NZJf Surg 1995; 65: 48-50.","journal-title":"Aust NZJf Surg"},{"key":"ref_27","first-page":"1431","article-title":"Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study","volume-title":"BrJtSurg","volume":"78","author":"Speakman, C.T.M.; Madden, M.V.; Nicholls, R.J.; Kamm, M.A.","year":"1991","unstructured":"Speakman CTM, Madden MV, Nicholls RJ, Kamm MA. Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. BrJtSurg 1991; 78: 1431-3."}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.39.1.120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T07:32:25Z","timestamp":1765006345000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.39.1.120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,7]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[1996,7,1]]},"published-print":{"date-parts":[[1996,7]]}},"alternative-id":["10.1136\/gut.39.1.120"],"URL":"https:\/\/doi.org\/10.1136\/gut.39.1.120","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1996,7]]}}}