Skip main navigation

New offer! Get 30% off one whole year of Unlimited learning. Subscribe for just £249.99 £174.99. New subscribers only. T&Cs apply

Find out more

Anal sphincter and pelvic floor damage

Read this article to find out more about the causes of anal sphincter and pelvic floor damage.
Damage to one or both anal sphincters (internal and/or external) is the most common cause of faecal incontinence in younger people, particularly women after childbirth.

Sultan et al (1993)[1], using endoanal ultrasound, found evidence of new anal sphincter damage in 35% of women after a first delivery. Childbirth trauma may not present as a problem until later in life, particularly around the menopause.

Risk factors for anal sphincter damage following childbirth (known as OASIS – Obstetric Anal Sphincter InjurieS) :

  • Vaginal delivery using instruments eg forceps
  • Episiotomy – especially midline
  • 3rd or 4th degree tear
  • Long labour with prolonged pushing
  • First delivery
  • Birth weigh over 4kg
  • Maternal age over 30


Sultan AH, Kamm MA, Hudson CN, Thomas J, Bartrum CI. Anal sphincter disruption during vaginal delivery. New England Journal of Medicine. 1993;329;1905-1911. [Cited 31 July 2018] Accessed from:

© Association for Continence Advice. CC BY-NC 4.0
This article is from the free online

Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

Created by
FutureLearn - Learning For Life

Reach your personal and professional goals

Unlock access to hundreds of expert online courses and degrees from top universities and educators to gain accredited qualifications and professional CV-building certificates.

Join over 18 million learners to launch, switch or build upon your career, all at your own pace, across a wide range of topic areas.

Start Learning now