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In women, the most common cause of sphincter injury is vaginal childbirth. The risk is increased if a woman has a large baby; is older than usual at the time of delivery; a long second stage of labor (pushing); a forceps delivery, or a tear that extends to the anus; or an episiotomy (an incision to extend the vaginal opening in an attempt to avoid a tear). The anal sphincters can also be damaged during rectal surgery (to treat prolapse, hemorrhoids, malformations, or rectal cancer), traumatic injury, or forceful anal intercourse.
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