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Counseling after perineal laceration: does it improve functional outcome?

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Abstract

Introduction and hypothesis

Since 2006, the Lausanne University Hospital (CHUV) has offered a 12-week post-partum perineum consultation for patients with third-/fourth-degree tears, providing advice for future deliveries. This study consisted of a retrospective follow-up of these patients, focused on subsequent deliveries and current urinary and anorectal incontinence symptoms.

Methods

Patients meeting eligibility criteria were invited to complete a questionnaire on their deliveries, along with validated questionnaires grading urinary (UDI-6 and IIQ-7) and anorectal (Wexner-Vaizey score) incontinence.

Results

Sixty-two percent of third-/fourth-degree tears occurred following operative vaginal deliveries. Of 160 participants, 45.6% did not redeliver, 5.6% of whom felt traumatized by their first delivery and reluctant to have another children; 33.2% had a second vaginal delivery, 19.4% had a cesarean section (CS), and 1.2% had both vaginal and CS deliveries; 28% of the CS were not medically indicated. The recurrence rate of third-/fourth-degree tears for subsequent vaginal deliveries was 3.6%.

Most patients were mildly or not affected by incontinence symptoms. Symptomatic patients reported urinary incontinence during physical activity and gas leakages; 50–60% saw no change of symptoms since the consultation, 30–40% reported partial or complete recovery. Patients redelivering by CS reported significantly less urinary incontinence (p = 0.046) and less anorectal incontinence (p = 0.069).

Conclusion

Anal sphincter laceration is associated with urinary and anorectal incontinence, but symptoms improve or disappear in most cases and are globally not invalidating. Perineal physiotherapy seems to contribute to this positive evolution. Fertility rate among these patients is unaffected, but the CS rate is higher than average. Further consideration of sexual and emotional sequelae could improve our current service.

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Acknowledgements

Our thanks to Sarah Guidon for collecting the questionnaires and delivery medical notes.

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Authors and Affiliations

  1. Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre Decker 2, 1011, Lausanne, Switzerland

    Ashley Vasseur, Karine Lepigeon, David Baud, Antje Horsch, Sylvain Meyer, Yvan Vial & Chahin Achtari

  2. Institute of Higher Education in Healthcare Research (IUFRS), University of Lausanne, Lausanne, Switzerland

    Antje Horsch

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  1. Ashley Vasseur
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  2. Karine Lepigeon
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  3. David Baud
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  5. Sylvain Meyer
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  7. Chahin Achtari
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Correspondence to Chahin Achtari.

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Vasseur, A., Lepigeon, K., Baud, D. et al. Counseling after perineal laceration: does it improve functional outcome?. Int Urogynecol J 30, 925–931 (2019). https://doi.org/10.1007/s00192-018-3712-5

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  • DOI: https://doi.org/10.1007/s00192-018-3712-5

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