What is an Anal Sphincter Injury and when do they happen?
Injury can happen during childbirth as a result of tearing to the vagina, perinium and the anus, or can also be as a result of an episiotomy, which is a surgical cut from the vagina into the perineum in a controlled manner to assist delivery. Tears are graded based upon the severity of the injury.
The most serious tears, grade 3 or 4, are where the injury extends into the anal sphincter. These are known as Anal Sphincter Injuries.
Although tears can be a non-negligent consequence of delivery, severe tears can result in a significant injury to the mother or birthing person. They can cause long term issues with bowel and sexual function, which can be devastating with life long impact.
Why was the Review needed and why is it important?
£60 million compensation was paid to Claimants who had suffered avoidable Obstetric Anal Sphincter Injuries (“anal spchinter injuries”) between 2011 to 2022.
In December 2025, NHS Resolution (the legal representative of the NHS) completed a thematic review in collaboration with the Royal College of Obstetricians and Gynaecologists, identifying themes and trends associated with Anal Sphincter Injuries associated with childbirth that have been successful over the last 10 years.
The goal was to analyse what has happened in the past, and to identify areas of improvement to support maternity units in diagnosing and raising greater awareness of these injuries so that they can be addressed at the earliest possible opportunity.
The injuries analysed were admitted by the NHS as being a result of care that fell below the standard expected from medical practitioners. Anal Sphincter Injuries were the fourth highest indication for claims between 1 April 2000 and 31 March 2010.
What was identified by the Review?
The report identified key points that led to a mother or birthing person bringing a claim for medical negligence relating to an Anal Sphincter Injury.
- 58% of claims related to a misdiagnosis of a perineal tear that was more severe than was initially thought. This means that they were diagnosed with a tear which was considered to be a grade 2 tear or lower, but in fact the tear had extended into the anal sphincter and should have been diagnosed as a grade 3 or 4 tear at the time of delivery. On average, the more severe injuries to the anal sphincter took 294 days to diagnose according to the analysis of the information from claims over the last 10 years.
- A recurring theme with these claims related to the circumstances of the birth. It was identified that 61% of claimants who suffered Anal Sphincter Injuries had an assisted delivery, with forceps involved in 54% of births, and 70% of deliveries with forceps also involved a surgical cut from the vagina extending into the perineum (episiotomy). This identified that clinicians should be considering and evaluating whether an Anal Sphincter Injury took place when an assisted delivery has taken place.
- The most common symptoms identified from the review were faecal incontinence, faecal urgency, pyschological symptoms, sexual dysfunction and perineal pain.
The review identified that the Claimants experienced faecal incontinence in 77% of cases, with pain being the second most common reported symptom in 74% of cases.
Faecal incontinence was identified as the main risk of an unidentified Anal Sphincter Injury, which can develop and progress long after delivery. Claimants reported suffering from urge incontinence, which means that they would experience a sudden sensation to pass faeces, but would fail to reach the toilet in time. This understandably effects the Claimant’s quality of life.
- The treatment that Claimants required in the successful claims included pelvic floor therapy in 24% of cases, surgical procedures including repair of the anal sphincter in 19% of cases, 12% required a defunctioning colostomy and 7% required a repair of a fistula.
What improvements did the Review recommend?
The review identified key areas for improvement in order to reduce the impact of Anal Sphincter Injuries, with a strong emphasis on awareness of the injury and a thorough assessment after delivery.
The review recommended training relating to instrumental delivery, including how to avoid excessive force when using ventouse or forceps with episiotomy during delivery, as well as the assessment for an Anal Sphincter Injury.
It was identified that the majority of births that were analysed by the reivew were conducted by junior doctors (56%) or midwives (29%). The review highlighted the importance of training about diagnosis and assessment of Anal Sphincter Injuries in these specialisms. Adequate support for junior doctors and midwives was also recommended for when they were dealing with complex deliveries.
Overall, the report focused on increasing awareness of the type of injury that can be sustained, along with the significant effects that this can have on women and birthing people. Increased awareness was identified as a key factor in promoting earlier diagnosis and treatment for women and birthing people who sustained these types of injuries.
What is our role as a Medical Negligence Law Firm?
The conclusions reached by the Review mirrors our experience as medical negligence solicitors, it is often not so much about the injury that has been sustained, but the delay in diagnosing and treating the injury at the earliest opportunity which causes the significant harm.
In our experience, early treatment can be the difference between a swift recovery versus an injury that has life long consequences.
We have previously acted for a client who experienced ongoing pain and incontinence after she had her baby, which was explained to her as being as a result of haemorrhoids. Unfortunately, she had to experience symptoms of diarrhoea, stomach cramps and blood in her stool before she was referred to a urogynaecologist and then a colorectal surgeon.
She was finally diagnosed with an anal sphincter injury much later than she should have been. Our investigation noted that she had a grade 4 anal sphincter tear, and with earlier diagnosis and treatment she would have avoided the permanent faecal urgency and incontinence. Her case settled for a 6 figure sum, as a result of the life-long avoidable difficulties that she faced. If you would like to read more about this case, please click here.
MDS welcomes the Review and its findings, and we look forward to seeing the recommendations implemented in order to minimise the impact that these life-long devastating injuries can have on women and birthing people.
Lauren Kerse, Associate Director and Specialist Medical Negligence Solicitor from MDS, said “Training and awareness of anal sphincter injuries must be implemented across NHS Trusts in order to minimise the impact that delay in diagnosis can have on women and birthing people in the UK. The analysis of successful medical negligence claims for these types of injuries speaks for itself, and it is clear the purposeful implementation of the recommendations will have a substantial impact on the lives of women and birthing people who sustain these injuries.”
