Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth

Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 06/2012; 207(5). DOI: 10.1016/j.ajog.2012.06.055
Source: PubMed

ABSTRACT OBJECTIVE: The purpose of this study was to investigate the long-term impact of anal sphincter laceration on anal incontinence. STUDY DESIGN: Five to 10 years after first delivery, anal incontinence and other bowel symptoms were measured with the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetric exposures were assessed with review of hospital records. Symptoms and quality-of-life impact were compared among 90 women with at least 1 anal sphincter laceration, 320 women who delivered vaginally without sphincter laceration, and 527 women who delivered by cesarean delivery. RESULTS: Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio, 2.32; 95% confidence interval, 1.27-4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality-of-life scores were similar between women who delivered by cesarean section and those who delivered vaginally without sphincter laceration. CONCLUSION: Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery.

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    • "La prévalence de l'IA est assez variable dans la littérature à moyen et long terme après le 1 er accouchement, tant pour l'IA globale que pour les différents types d'IA. Dans l'étude de cohorte d'Evers et al., le taux d'IA était de 19 % dans le groupe E et 10 % dans le groupe NE (p = 0,01) 5 à 10 ans après le premier accouchement [11] avec une différence significative persistante même pour l'IA aux gaz (31 % des patientes ayant eu une déchirure du 3 e ou 4 e degré vs et 23 % des patientes sans déchirure sévère, p < 0,01). Dans l'étude cas-témoin de Baud et al. sur 196 femmes ayant eu une déchirure sévère et 588 femmes sans, la prévalence de l'IA était de 57,4 % (groupe E) vs 39,5 % (groupe NE) ; la différence étant significative (p = 0,01). "
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    Progrès en Urologie 05/2015; 25(9). DOI:10.1016/j.purol.2015.04.003 · 0.77 Impact Factor
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    • "The overall incidence of normal continence following a primary repair of OASI by experienced obstetricians in the present study was comparable to that found in previous studies, which have reported normal continence rates ranging between 41% and 86% [11] [12] [13] [14]. Furthermore, most women with OASI had a modified Wexner score of less than 3, indicating that the majority of women had only minor symptoms with low impact on lifestyle. "
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    ABSTRACT: Objective To examine the long-term outcomes of women with obstetric anal sphincter injury (OASI) repaired by obstetricians without the involvement of colorectal surgeons. Methods A retrospective cohort study was undertaken of women who had been admitted for delivery between 2004 and 2012. All OASIs had been repaired by experienced obstetricians using the end-to-end technique. An unexposed group (no OASI) was matched at a ratio of 1:1. Fecal incontinence was graded using a modified Wexner questionnaire. Results Overall, 113 OASIs were recorded. Sixty-seven (59.3%) and 71 (62.8%) women from the exposed and unexposed groups, respectively, agreed to participate in the study (P = 0.9). Continence to both stool and gas was reported by 48 (71.6%) and 64 (90.1%) women in the exposed and unexposed groups, respectively (P = 0.03). The incidence of urgency, dyspareunia, and use of a pad or constipating agents was the same in both groups. Conclusion The long-term outcome of OASI repair performed by experienced obstetricians is comparable to that reported in the literature. Some women who did not sustain an OASI reported fecal incontinence, which suggests that only a proportion of fecal incontinence can be attributed to OASI.
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    ABSTRACT: Pelvic floor disorders affect women of all ages and are associated with significant economic burden and poor quality of life. Current literature suggests an association between childbirth and these disorders. In this review, we summarize recent advancements in our understanding of this association. Vaginal childbirth appears to be strongly associated with stress urinary incontinence and pelvic organ prolapse. There is less evidence to suggest an association between vaginal delivery and overactive bladder symptoms. History of more than one perineal laceration increases the likelihood of developing prolapse. Similar association has not been established for episiotomy. Disruption or denervation of structural components of pelvic floor support system, particularly levator ani muscle complex, is associated with later development of pelvic floor disorders. Imbalance in homeostasis of connective tissue remodeling of the vaginal wall from overstretching during childbirth is another possible mechanism. Pelvic floor disorders represent a significant health problem affecting women of all ages. Identification of potential modifiable risk factors and advancement in understanding of the underlying pathophysiology is crucial for primary and secondary prevention of these disorders and for improvement in treatment strategies.
    Current opinion in obstetrics & gynecology 08/2012; 24(5):349-54. DOI:10.1097/GCO.0b013e328357628b · 2.37 Impact Factor
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