Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury

Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 07/2007; 114(6):736-40. DOI: 10.1111/j.1471-0528.2007.01331.x
Source: PubMed


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.

Download full-text


Available from: Maeve Eogan, Sep 22, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: The postpartum period is a time of significant emotional, social, and physical change for most women. This review focuses on recent evidence supported by systematic reviews and randomized, controlled trials to guide the care of postpartum women who are otherwise healthy. Mental health outcomes are improved with postpartum support in at-risk women. Postpartum depression can be treated either pharmacologically or with counseling; however, exercise and omega-3 fatty acids are emerging as potentially effective alternatives. Intrauterine devices are safe and effective methods of contraception in the postpartum period. There has yet to be an effective, postpartum, smoking-cessation program developed, although intensive motivational counseling shows some promising early results. Bladder dysfunction continues to be a significant problem for women even at 10 years postpartum. Pelvic floor muscle exercises can help prevent and treat incontinence at 12 months, but longer-term follow-up studies are needed. Prevalence studies suggest that bowel dysfunction is common in the postpartum period, but randomized, controlled trials are limited to treatment in women with third-degree perineal damage. Although some recommendations can be made for evidence-based postpartum care, many important questions related to the postpartum period have not been examined by rigorous methodologies.
    No preview · Article · Jan 2008 · Current Opinion in Obstetrics and Gynecology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Prospective studies up to 1 year after repair of obstetric anal sphincter injuries (OASIS) report anal incontinence in 33% of women and up to 92% have a sonographic sphincter defect. The aim of this study is to determine the outcome of repair by doctors who have undergone structured training using a standardized protocol. Doctors repaired OASIS after attending a training workshop. The external anal sphincter was repaired by the end-to-end technique when partially divided and the overlap method when completely divided. Endoanal ultrasound was performed prior to suturing and 7 weeks later. A validated bowel symptom questionnaire was completed prior to delivery, at 7 weeks postpartum, and at 1 year postpartum. Fifty-nine women sustained OASIS. At 7 weeks, six (10%) had a defect on ultrasound. There was no significant deterioration in symptoms of fecal urgency, incontinence, or quality of life at 1 year after delivery. The 1-year outcome after repair of OASIS appears to be good when repaired by doctors after structured training.
    Full-text · Article · Jun 2009 · International Urogynecology Journal
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Sep 2009 · Obstetrics and Gynecology Clinics of North America
Show more