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Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery

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Abstract

Introduction and hypothesis

This study aims to estimate fecal, urinary incontinence, and sexual function 6 years after an obstetrical anal sphincter tear.

Methods

Among 13,213 women who had a vaginal delivery of a cephalic singleton at term, 196 women sustained an anal sphincter tear. They were matched to 588 controls. Validated questionnaires grading fecal and urinary incontinence, and sexual dysfunction were completed by the participants.

Results

Severe fecal incontinence was more frequently reported by women who had sustained an anal sphincter tear compared to the controls. Women with an anal sphincter tear had no increased risk of urinary incontinence, but reported significantly more pain, difficulty with vaginal lubrication, and difficulty achieving orgasm compared to the controls. A fetal occiput posterior position during childbirth was an independent risk factor for both severe urinary incontinence and severe sexual dysfunction.

Conclusions

Fecal incontinence is strongly associated with an anal sphincter tear. A fetal occiput posterior position represents a risk factor for urinary incontinence and sexual dysfunction.

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References

  1. Fitzgerald MP, Weber AM, Howden N, Cundiff GW, Brown MB (2007) Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol 109:29–34

    Article  PubMed  Google Scholar 

  2. Wheeler TL, Richter HE (2007) Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol 19:474–479

    Article  PubMed  Google Scholar 

  3. Dudding TC, Vaizey CJ, Kamm MA (2008) Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 247:224–237

    Article  PubMed  Google Scholar 

  4. Vaccaro C, Clemons JL (2008) Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women. Int Urogynecol J Pelvic Floor Dysfunct 19:1503–1508

    Article  PubMed  Google Scholar 

  5. Mous M, Muller SA, de Leeuw JW (2008) Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints. BJOG 115:234–238

    PubMed  CAS  Google Scholar 

  6. Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J (2004) Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol 104:1397–1402

    Article  PubMed  Google Scholar 

  7. Fornell EU, Matthiesen L, Sjodahl R, Berg G (2005) Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG 112:312–316

    Article  PubMed  Google Scholar 

  8. Nygaard IE, Rao SS, Dawson JD (1997) Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol 89:896–901

    Article  PubMed  CAS  Google Scholar 

  9. Nordenstam J, Altman D, Brismar S, Zetterstrom J (2009) Natural progression of anal incontinence after childbirth. Int Urogynecol J Pelvic Floor Dysfunct 20:1029–1035

    Article  PubMed  Google Scholar 

  10. Faltin DL, Boulvain M, Floris LA, Irion O (2005) Diagnosis of anal sphincter tears to prevent fecal incontinence: a randomized controlled trial. Obstet Gynecol 106:6–13

    Article  PubMed  Google Scholar 

  11. Otero M, Boulvain M, Bianchi-Demicheli F, Floris LA, Sangalli MR, Weil A, Irion O, Faltin DL (2006) Women's health 18 years after rupture of the anal sphincter during childbirth: II. urinary incontinence, sexual function, and physical and mental health. Am J Obstet Gynecol 194:1260–1265

    Article  PubMed  Google Scholar 

  12. Scheer I, Andrews V, Thakar R, Sultan AH (2008) Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship? Int Urogynecol J Pelvic Floor Dysfunct 19:179–183

    Article  PubMed  Google Scholar 

  13. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1549

    Article  PubMed  Google Scholar 

  14. Wagenius J, Laurin J (2003) Clinical symptoms after anal sphincter rupture: a retrospective study. Acta Obstet Gynecol Scand 82:246–250

    Article  PubMed  Google Scholar 

  15. Brubaker L, Handa VL, Bradley CS, Connolly A, Moalli P, Brown MB, Weber A (2008) Sexual function 6 months after first delivery. Obstet Gynecol 111:1040–1044

    Article  PubMed  Google Scholar 

  16. Sultan AH, Monga AK, Kumar D, Stanton SL (1999) Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 106:318–323

    Article  PubMed  CAS  Google Scholar 

  17. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  18. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80

    Article  PubMed  CAS  Google Scholar 

  19. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res 3:291–306

    Article  PubMed  CAS  Google Scholar 

  20. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14:131–139

    Article  PubMed  CAS  Google Scholar 

  21. Meston CM (2003) Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther 29:39–46

    Article  PubMed  Google Scholar 

  22. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208

    Article  PubMed  CAS  Google Scholar 

  23. Mahony R, Behan M, Daly L, Kirwan C, O'Herlihy C, O'Connell PR (2007) Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injury. Am J Obstet Gynecol 196:217.e1-5

    Article  PubMed  Google Scholar 

  24. Faltin DL, Otero M, Petignat P, Sangalli MR, Floris LA, Boulvain M, Irion O (2006) Women's health 18 years after rupture of the anal sphincter during childbirth: I. fecal incontinence. Am J Obstet Gynecol 194:1255–1259

    Article  PubMed  Google Scholar 

  25. Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31:1–20

    Article  PubMed  Google Scholar 

  26. Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries—myth or reality? BJOG 113:195–200

    Article  PubMed  Google Scholar 

  27. Holroyd-Leduc JM, Straus SE (2004) Management of urinary incontinence in women: scientific review. JAMA 291:986–995

    Article  PubMed  CAS  Google Scholar 

  28. Sultan AH, Kamm MA, Hudson CN (1994) Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol 101:22–28

    Article  PubMed  CAS  Google Scholar 

  29. Allen RE, Hosker GL, Smith AR, Warrell DW (1990) Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 97:770–779

    Article  PubMed  CAS  Google Scholar 

  30. Snooks SJ, Setchell M, Swash M, Henry MM (1984) Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 2:546–550

    Article  PubMed  CAS  Google Scholar 

  31. Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712

    Article  PubMed  Google Scholar 

  32. Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 107:144–149

    Article  PubMed  Google Scholar 

  33. Fitzpatrick M, McQuillan K, O'Herlihy C (2001) Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol 98:1027–1031

    Article  PubMed  CAS  Google Scholar 

  34. Ponkey SE, Cohen AP, Heffner LJ, Lieberman E (2003) Persistent fetal occiput posterior position: obstetric outcomes. Obstet Gynecol 101:915–920

    Article  PubMed  Google Scholar 

  35. Simkin P (2010) The fetal occiput posterior position: state of the science and a new perspective. Birth 37:61–71

    Article  PubMed  Google Scholar 

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Acknowledgment

We thank all midwives and doctors who computerized obstetrical data used in this study. Their involvement was essential to the whole process and they enthusiastically gave their time to allow this study. We thank Cristina Lyko, Sarah Guidon, Christian Sinobas and Andre Baud for computer assistance, Olivia and Felix Sandri for sending the questionnaire, Kelsey Mills and Paulina Cybulska for critical review of the manuscript.

Funding

The study was funded by the Foundation for Research and Development in Gynecology and Obstetrics of Lausanne, Switzerland. David Baud is supported by the "Société Académique Vaudoise" through the "Paul Blanc" grant and the SICPA Foundation. The funding sources had no role in the study design, data collection, data analysis or the interpretation thereof, or writing of the report.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital of Lausanne, Maternity-CHUV, 1011, Lausanne, Switzerland

    David Baud, Sylvain Meyer, Yvan Vial, Patrick Hohlfeld & Chahin Achtari

Authors
  1. David Baud
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  2. Sylvain Meyer
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  3. Yvan Vial
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  4. Patrick Hohlfeld
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  5. Chahin Achtari
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Correspondence to Chahin Achtari.

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Baud, D., Meyer, S., Vial, Y. et al. Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Int Urogynecol J 22, 1127–1134 (2011). https://doi.org/10.1007/s00192-011-1431-2

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  • DOI: https://doi.org/10.1007/s00192-011-1431-2

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