DEFINITION: - Tear of the perineal body involving the sphincter ani externus with or without involvement of the anorectal mucosa is called complete perineal tear. It is called old when passed beyond an arbitrary period of 3 months following the injury.
ETIOLOGY: -
♦ Obstetrical
♦ Gynecological
Obstetrical: Perineal injury (3° and 4°) results from over stretching or sudden stretching of the perineum during child birth. It is more common when the perineum is inelastic.
CLINICAL FEATURES: Patient profile
Patients are usually primiparous with a history suggestive of inadequate care during childbirth.
Symptoms— The chief complaints are:
Palpation: There is absence of the sphincteric grip evidenced when a finger is introduced into the rectum. The anal canal is separated from the vagina only by a septum. It is surprising that in spite of deficit of the perineum, there is no prolapse. This is because of over-activity of the levator ani muscle. If prolapse is found along with CPT, it is more likely pre-existing.
DIFFERENTIAL DIAGNOSIS: A rectovaginal fistula situated low down may at times be confused with complete perineal tear. This is especially in cases where overlying skin remains intact. Rectovaginal fistula causes more inconvenience to the patient than CPT.
The medicines that can be thought of after considering the totality of symptoms and symptom similarity are:-