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: 4.7). 06/2012; 207(5). DOI: 10.1016/j.ajog.2012.06.055
Source: PubMed


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.

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.

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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    ABSTRACT: Évaluer la prévalence de l’incontinence anale (IA) et urinaire (IU) à moyen terme après déchirure périnéale du 3e et 4e degré et leur impact sur la sexualité et la qualité de vie des femmes.
    Progrès en Urologie 05/2015; 25(9). DOI:10.1016/j.purol.2015.04.003 · 0.66 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.
    International Journal of Gynecology & Obstetrics 08/2014; 126(2). DOI:10.1016/j.ijgo.2014.03.025 · 1.54 Impact Factor
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    • "All studies, however, evaluated third- and fourth-degree anal sphincter injuries together and made no separation between whether the external anal sphincter is partly damaged or entirely disrupted which is of great clinical importance since the long-term outcome for the women depends on the degree of the laceration as well as the adequacy of the primary repair [12, 13]. "
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    ABSTRACT: Objective: To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods: The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5-24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results: The overall prevalence of third- or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28-0.78. Conclusion: Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.
    BioMed Research International 04/2014; 2014(2):395803. DOI:10.1155/2014/395803 · 3.17 Impact Factor
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