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Postpartum anal incontinence in women with and without obstetric anal sphincter injuries

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Abstract

Introduction and hypothesis

Postpartum anal incontinence is common and distressing for women. We sought to look at the prevalence of anal incontinence in women who sustained obstetric anal sphincter injuries (OASI) compared with women who did not, and factors leading to these symptoms during the postpartum period.

Methods

A total of 129 primiparous women sustaining OASI were compared with 131 women who did not (controls). They were contacted at approximately 6–10 weeks postpartum to obtain information on their symptoms of anal incontinence (AI). The data underwent univariate and multivariate analysis.

Results

There was no difference in the prevalence of AI symptoms, occurring in 30% of women with OASI, and 23% of women without at 6–10 weeks postpartum; however, in women with high-grade tears the prevalence was 59%. Severe OASI (grade 3c and 4) was associated with an increased prevalence of both AI and severe AI, whereas forceps delivery and increasing maternal age were associated with an increased prevalence of severe AI only.

Conclusion

Women with less severe (grade 3a and 3b) OASI do not experience a higher prevalence of AI than women without OASI in the postpartum period. Higher grade (3c and 4) tears, forceps delivery and increasing maternal age are associated with higher rates of AI. These factors should be avoided where possible to reduce postpartum AI. All women should be warned of the 23–30% chance of experiencing some mild AI in this period. Whether these symptoms are transient or long-lasting requires further investigation.

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Abbreviations

AI:

Anal incontinence

OASI:

Obstetric anal sphincter injury

SMIS:

St Mark’s Incontinence Score

References

  1. Nordenstam J, Altman D, Brismar S, Zetterstrom J. Natural progression of anal incontinence after childbirth. Int Urogynecol J. 2009;20(9):1029–35. https://doi.org/10.1007/s00192-009-0901-2.

    Article  Google Scholar 

  2. Gommesen D, Nohr EAA, Qvist N, Rasch V. Obstetric perineal ruptures—risk of anal incontinence among primiparous women 12 months postpartum: a prospective cohort study. Am J Obstet Gynecol. 2020;222(2):165.e1-11. https://doi.org/10.1016/j.ajog.2019.08.026.

    Article  Google Scholar 

  3. Tucker J, Clifton V, Wilson A. Teetering near the edge; women’s experiences of anal incontinence following obstetric anal sphincter injury: an interpretive phenomenological research study. Aust N Z J Obstet Gynaecol. 2014;54(4):377–81. https://doi.org/10.1111/ajo.12230.

    Article  PubMed  Google Scholar 

  4. Sultan AH. Editorial: obstetrical perineal injury and anal incontinence. Clin Risk. 1999;5(6):193–6. https://doi.org/10.1177/135626229900500601.

    Article  Google Scholar 

  5. Solans-Domenech M, Sanchez E, Espuna-Pons M, Pelvic Floor Research Group. Urinary and anal incontinence during pregnancy and postpartum incidence, severity, and risk factors. Obstet Gynecol. 2010;115(3):618–28. https://doi.org/10.1097/AOG.0b013e3181d04dff.

    Article  PubMed  Google Scholar 

  6. Fitzpatrick M, O’Herlihy C. The effects of labour and delivery on the pelvic floor. Best Pract Res Clin Obstet Gynaecol. 2001;15(1):63–79. https://doi.org/10.1053/beog.2000.0149.

    Article  CAS  PubMed  Google Scholar 

  7. Burgio KL, Borello-France D, Richter HE, FitzGerald MP, Whitehead W, Handa VL, et al. Risk factors for fecal and urinary incontinence after childbirth: the childbirth and pelvic symptoms study. Am J Gastroenterol. 2007;102(9):1998–2004. https://doi.org/10.1111/j.1572-0241.2007.01364.x.

    Article  PubMed  Google Scholar 

  8. Bols EMJ, Hendriks EJM, Berghmans BCM, Baeten C, Nijhuis JG, De Bie RA. A systematic review of etiological factors for postpartum fecal incontinence. Acta Obstet Gynecol Scand. 2010;89(3):302–14. https://doi.org/10.3109/00016340903576004.

    Article  PubMed  Google Scholar 

  9. Burrell M, Dilgir S, Patton V, Parkin K, Karantanis E. Risk factors for obstetric anal sphincter injuries and postpartum anal and urinary incontinence: a case-control trial. Int Urogynecol J. 2015;26(3):383–9. https://doi.org/10.1007/s00192-014-2478-7.

    Article  PubMed  Google Scholar 

  10. Roos AM, Sultan AH, Thakar R. St. Mark’s incontinence score for assessment of anal incontinence following obstetric anal sphincter injuries (OASIS). Int Urogynecol J. 2009;20(4):407–10. https://doi.org/10.1007/s00192-008-0784-7.

    Article  Google Scholar 

  11. Linneberg S, Leenskjold S, Glavind K. A five year follow-up of women with obstetric anal sphincter rupture at their first delivery. Eur J Obstet Gynecol Reprod Biol. 2016;203:315–9. https://doi.org/10.1016/j.ejogrb.2016.06.018.

    Article  PubMed  Google Scholar 

  12. Box GEP, Tidwell PW. Transformation of independent variables. Technometrics. 1962;4(4):531. https://doi.org/10.2307/1266288.

    Article  Google Scholar 

  13. Ramalingam K, Monga AK. Outcomes and follow-up after obstetric anal sphincter injuries. Int Urogynecol J. 2013;24(9):1495–500. https://doi.org/10.1007/s00192-013-2051-9.

    Article  CAS  PubMed  Google Scholar 

  14. Nazir M, Stien R, Carlsen E, Jacobsen AF, Nesheim BI. Early evaluation of bowed symptoms after primary repair of obstetric perineal rupture is misleading—an observational cohort study. Dis Colon Rectum. 2003;46(9):1245–50. https://doi.org/10.1097/01.dcr.0000084340.44237.3b.

    Article  PubMed  Google Scholar 

  15. Faltin DL, Boulvain M, Floris LA, Irion O. Diagnosis of anal sphincter tears to prevent fecal incontinence—a randomized controlled trial. Obstet Gynecol. 2005;106(1):6–13. https://doi.org/10.1097/01.aog.0000165273.68486.95.

    Article  PubMed  Google Scholar 

  16. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JOL. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189(6):1543–9. https://doi.org/10.1016/j.ajog.2003.09.030.

    Article  PubMed  Google Scholar 

  17. Johannessen HH, Wibe A, Stordahl A, Sandvik L, Backe B, Morkved S. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG. 2014;121(3):269–80. https://doi.org/10.1111/1471-0528.12438.

    Article  CAS  PubMed  Google Scholar 

  18. Laine K, Skjeldestad FE, Sanda B, Horne H, Spydslaug A, Staff AC. Prevalence and risk factors for anal incontinence after obstetric anal sphincter rupture. Acta Obstet Gynecol Scand. 2011;90(4):319–24. https://doi.org/10.1111/j.1600-0412.2010.01057.x.

    Article  PubMed  Google Scholar 

  19. Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, et al. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum. 2000;43(5):590–6. https://doi.org/10.1007/bf02235567.

    Article  CAS  PubMed  Google Scholar 

  20. Nelson RL, Go C, Darwish R, Gao JP, Parikh R, Kang C, et al. Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis. Tech Coloproctol. 2019;23(9):809–20. https://doi.org/10.1007/s10151-019-02029-3.

    Article  CAS  PubMed  Google Scholar 

  21. Deane RP. Operative vaginal delivery and pelvic floor complications. Best Pract Res Clin Obstet Gynaecol. 2019;56:81–92. https://doi.org/10.1016/j.bpobgyn.2019.01.013.

    Article  PubMed  Google Scholar 

  22. Joris F, Hoesli I, Kind A, Ries J, Kavvadias T. Obstetrical and epidemiological factors influence the severity of anal incontinence after obstetric anal sphincter injury. BMC Pregnancy Childbirth. 2019;19:7. https://doi.org/10.1186/s12884-019-2238-2.

    Article  Google Scholar 

  23. Pretlove SJ, Thompson PJ, Toozs-Hobson PM, Radley S, Khan KS. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review. BJOG. 2008;115(4):421–34. https://doi.org/10.1111/j.1471-0528.2007.01553.x.

    Article  CAS  PubMed  Google Scholar 

  24. Kamm MA. Obstetric damage and fecal incontinence. Lancet. 1994;344(8924):730–3. https://doi.org/10.1016/s0140-6736(94)92213-6.

    Article  CAS  PubMed  Google Scholar 

  25. Sultan AH, Kamm MA. Faecal incontinence after childbirth. Br J Obstet Gynaecol. 1997;104(9):979–82.

    CAS  PubMed  Google Scholar 

  26. Sorensen M, Tetzschner T, Rasmussen OO, Bjarnesen J, Christiansen J. Sphincter rupture in childbirth. Br J Surg. 1993;80(3):392–4. https://doi.org/10.1002/bjs.1800800343.

    Article  CAS  PubMed  Google Scholar 

  27. Caudwell-Hall J, Atan IK, Brown C, Rojas RG, Langer S, Shek KL, et al. Can pelvic floor trauma be predicted antenatally? Acta Obstet Gynecol Scand. 2018;97(6):751–7. https://doi.org/10.1111/aogs.13315.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Pelvic Floor Unit, St George Hospital, Sydney, New South Wales, Australia

    Rebecca Everist, Katrina Parkin & Emmanuel Karantanis

  2. University of New South Wales, Sydney, Australia

    Rebecca Everist, Kylie-Ann Mallitt & Emmanuel Karantanis

  3. Calvary Hospital, Canberra, Australia

    Madeline Burrell

  4. NHMRC Early Career Fellow, Sydney, Australia

    Kylie-Ann Mallitt

  5. Centre for Big Data Research in Health, Sydney, Australia

    Kylie-Ann Mallitt

  6. Edith Cowan University, Joondalup, Australia

    Vicki Patton

Authors
  1. Rebecca Everist
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  2. Madeline Burrell
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  3. Kylie-Ann Mallitt
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  4. Katrina Parkin
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  6. Emmanuel Karantanis
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Contributions

R.E.: data analysis, manuscript writing; M.B.: protocol development, data collection, data analysis; K.M.: statistical guidance, manuscript editing; K.P.: data collection; V.P.: data collection; E.K.: project development, manuscript editing.

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Correspondence to Rebecca Everist.

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Everist, R., Burrell, M., Mallitt, KA. et al. Postpartum anal incontinence in women with and without obstetric anal sphincter injuries. Int Urogynecol J 31, 2269–2275 (2020). https://doi.org/10.1007/s00192-020-04267-8

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  • DOI: https://doi.org/10.1007/s00192-020-04267-8

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