We present an uncommon case of an anciente fourth degree birthing laceration with anus incontinence in a 77 years old lady.
Main steps of procedure as the following:
- vide sharp vaginal mucosa mobilitation exposing rectal fascia;
- renforcing rectal fascia;
- suturing anterior rectal wall tying knots inside lumen;
- renforcing overlaying fascia;
- preparing two retracted ends of sphincter ani and suturing by overlap technique;
- suturing levator ani branches in middline;
-suturing vaginal mucosa and perineal skin together with perineal transverse muscle.

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