A third-degree tear causes a significant emotional and psychological impact on women's physical and emotional well-being. We recommend that all staff receive adequate training to deal with the issues that may be raised. The provision of a dedicated, multidisciplinary team involved at an early stage to coordinate the repair and follow-up is recommended to allow a sensitive, consistent, evidence-based approach, particularly in terms of decision-making for subsequent births. The experiences and needs of partners require further study.

Objective To compare two surgical techniques and two types of suture material for anal sphincter repair after childbirth-related injury.Design Factorial randomised controlled trial.Setting Tertiary referral maternity unit.Population Women with an anal sphincter injury sustained during childbirth.Method Women were randomised into four groups: overlap repair with polyglactin (Vicryl); end-to-end repair with polyglactin (Vicryl); overlap repair with polydioxanone (PDS); and end-to-end repair with PDS. All repairs were completed as a primary procedure by staff trained in both methods.Main outcome measures Suture-related morbidity at six weeks. Bowel symptoms at 3, 6 and 12 months. Anorectal physiology at three months. Quality of life scores at 3 and 12 months.Results One hundred and fifty women (1.5% of deliveries) were eligible and 112 (75%) were randomised. One hundred and three (92%) attended follow up visit at 6 weeks, 89 (80%) at 3 months, 79 (71%) at 6 months and 60 (54%) at 12 months. At six weeks, there was no difference in suture-related morbidity between groups (P = 0.11) and 70% patients were completely asymptomatic. Incidence of bowel symptoms and quality of life disturbances were low, with no differences between the four groups.Conclusion Obstetric anal sphincter repair carried out by appropriately trained staff is associated with low morbidity, irrespective of the suture material and repair method used.Please cite this paper as: Williams A, Adams E, Tincello D, Alfirevic Z, Walkinshaw S, Richmond D. How to repair an anal sphincter injury after vaginal delivery: results of a randomised controlled trial.

This study investigated whether British women prefer to crouch over public toilet seats, and measured the effect of such a voiding position on urine flow rate and residual urine volume. Of 528 consecutive women who attended a general gynaecological clinic and completed an anonymous questionnaire, 85% usually crouched over the toilet when using a public convenience, 12% applied paper to the seat and 2% sat directly on public toilet seats. When using a friend's bathroom 38% of the women voided by crouching. Results were similar for 155 patients attending a urodynamic clinic, 80 of whom were studied while voiding in both positions. There was a 21% reduction in average urine flow rate and a 149% increase in residual urine volume in the crouching position. Women undergoing urodynamic tests should be asked which voiding position they used before abnormal results are interpreted. Patients with a reduced functional bladder capacity may benefit from being encouraged to sit comfortably on the toilet whenever possible.Anecdotal reports have suggested that many British women were taught by their mothers never to sit on the toilet seat in a strange bathroom. However, the extent to which this voiding ~~ ~~