Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury.
ABSTRACT To compare two postpartum laxative regimens in women who have undergone primary repair of obstetric anal sphincter injury.
Randomised controlled trial.
National Maternity Hospital, Dublin.
A total of 147 postpartum women who had sustained anal sphincter injury at vaginal birth.
Women were randomised to receive either lactulose alone thrice daily for the first three postpartum days followed by sufficient lactulose to maintain a soft stool over the following 10 days (lactulose group, n = 77) or the lactulose regimen combined with a sachet of ispaghula husk daily for the first 10 postpartum days (Fybogel group, n = 70). All patients kept a diary of bowel habit for the first 10 postpartum days and were invited to return for review at 3 months postpartum.
Patient discomfort with first postpartum bowel motion, incidence of postnatal constipation and incontinence and incontinence score in postnatal period.
Pain scores were similar in the two treatment groups; but incontinence in the immediate postnatal period was more frequent with the two preparations compared with lactulose alone (32.86% versus 18.18%, P = 0.03).
This study does not support routine prescribing of a stool-bulking agent in addition to a laxative in the immediate postnatal period for women who have sustained anal sphincter injury at vaginal delivery.
- SourceAvailable from: Eugene Oteng-Ntim
Article: Obstetric anal sphincter injury.[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE: An obstetrically damaged anal sphincter is the principal cause of the development of fecal incontinence in otherwise healthy females. Reports suggest that such damage complicates as many as 35 percent of primiparous vaginal deliveries, with 13 percent of first-time mothers becoming symptomatic. In maternity units delivering 3,000 patients annually, it would follow that 390 symptomatic patients would develop new symptoms each year. This incidence of dysfunction does not reflect current clinical practice. We have investigated this discrepancy to establish the actual incidence of anal sphincter trauma associated with childbirth. METHODS: During a six-week period, 159 females (105 primiparous and 54 para-I) were prospectively assessed postnatally using a standardized symptom questionnaire, endoanal ultrasound, and anal manometry. This group constituted 84 percent of all eligible deliveries occurring in the unit during the study period. RESULTS: One patient developed fecal urgency after this delivery; there were no reports of fecal incontinence. Anal sphincter injuries were identified ultrasonically in 6.8 percent of primiparous patients, 12.2 percent of para-I patients having vaginal deliveries, and 83 percent of patients having forceps deliveries overall. Manometric data provided confirmatory evidence, with significantly reduced maximum squeeze pressures in patients with a disrupted anal sphincter (PBMJ (online) 01/2010; 341:c3414. · 17.22 Impact Factor
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ABSTRACT: Posterior compartment disorders include anal incontinence, constipation, and defecatory dysfunction. These disorders cause considerable morbidity, and are typically underreported by patients and undertreated by providers. The purpose of this article is outline the approach to diagnosis and treatment of anal incontinence, constipation, and defecatory dysfunction with a brief description of the nature of the problem and approaches to evaluation and diagnosis, as well as medical and surgical management.Obstetrics and Gynecology Clinics of North America 09/2009; 36(3):673-97. · 1.45 Impact Factor
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ABSTRACT: Trauma sustained during childbirth is not always recognized, and damage to tissues and nerves may lead to long-term sequelae that can have a huge impact on the physical, social, and psychological well-being of women. However, even when trauma is recognized and repaired, the outcome may be suboptimal. Focused training in identification and appropriate repair is therefore mandatory. The two most important principles in primary repair of acute anal sphincter injuries are repair of the internal sphincter and restoration of the anal canal length. Subsequent vaginal delivery is not associated with adverse outcome in the majority of women. KeywordsAnal sphincter repair-Cesarean section-Childbirth-Fecal incontinence-Perineal trauma-Rectocele-Third- and fourth-degree tears12/2009: pages 143-153;