. The Principles and practice of gynecology : for students and practitioners. d still further in thelateral direction, as the head passes, and that an additional freshtear may occur at the posterior commissure of the vulva, makingthree wounds, all in awkward directions. A single incision in thedirection shown by the scissors in Figure 265 is preferable, for anyfurther tear will be to one side of the sphincter ani muscle instead ofthrough it. Complete Laceration through the sphincter ani muscle entirely 528 TRAUMATISMS. destroys the retentive power of tlie bowel. The rupture in rareinstances oc
. The Principles and practice of gynecology : for students and practitioners. d still further in thelateral direction, as the head passes, and that an additional freshtear may occur at the posterior commissure of the vulva, makingthree wounds, all in awkward directions. A single incision in thedirection shown by the scissors in Figure 265 is preferable, for anyfurther tear will be to one side of the sphincter ani muscle instead ofthrough it. Complete Laceration through the sphincter ani muscle entirely 528 TRAUMATISMS. destroys the retentive power of tlie bowel. The rupture in rareinstances occurs subcutaneously without a visible break in the cuta-neous surfaces around the anus. The diagnosis then depends uponthe presence of an open, relaxed anus. Relaxation of the sphincterand incontinence of the bowel may occur also independently oflaceration. Results. The results of incomplete laceration vary with the extent ofinjury and direction of the tear. The extent to which laceration isvisible to the eye is not a safe criterion, for, as already explained, FlQTJKE Downward pressure on the pelvic floor in labor. This figure shows how the muscles andfascia of the pelvic floor may be injured. CV, constrictor vaginse muscle. TP, transversusperinei muscle. Gm, gluteus maximus muscle. BC, bulbocavernous muscle. IRF, ischiorectalfascia. Coc, coccyx. The left transversus perinei muscle is being torn. the chief injury may be in the deeper structures, and recognized notby sight, but by the effects. The effects may not be apparent immedi-ately after labor; hence further examination is a necessary part of theefficient management of the puerperium. One examination shouldbe made immediately after labor, to recognize and at once repair suchinjury as may at that time be visible; another six weeks later, torecognize and repair any deeper injuries to the perineal fascia ormuscles. LACERATIONS OF THE PERINEUM. 529 Complete laceration, hciiii;- usually in the lucdiun line, does nottear t
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