International Urogynecology Journal

, Volume 24, Issue 1, pp 55–60 | Cite as

Anal and urinary incontinence 4 years after a vaginal delivery

  • Vasanth Andrews
  • Susan Shelmeridine
  • Abdul H. SultanEmail author
  • Ranee Thakar
Original Article


Introduction and hypothesis

Our purpose was to establish the incidence of anal and urinary incontinence 4 years following vaginal delivery in women with and without obstetric anal sphincter injuries (OASIS).


This was a prospective study of 241 having their first vaginal delivery who had independent verification and repair of OASIS by trained obstetricians. All obstetricians performing OASIS repairs had undergone structured hands-on training and were then directly supervised while repairing OASIS until they were deemed competent to repair independently. Patients were followed up for 4 years with validated bowel and urinary questionnaires. In order to minimise nonresponders, contact details were verified and obtained from their general practitioners, the local primary care trust and electoral roll.


Two hundred and fifty-four women were invited, and 241 (95 %) participated. Fifty-nine (25 %) women sustained OASIS. One hundred and forty-nine were contactable 4 years later, and 86 (58 %) agreed to participate in the study at 4 years. No woman had faecal incontinence, and there was no difference in rates of flatus incontinence prior to delivery up to 4 years postpartum, regardless of whether OASIS occurred or not. Urinary incontinence was more than four times more common after vaginal birth, and this was not affected by whether OASIS occurred and resulted in a significant deterioration in quality of life.


The previously reported higher rates of anal incontinence following OASIS can be minimised up to 4 years after delivery if repaired by trained doctors. There is a significant increase in urinary incontinence following vaginal delivery, and the mechanism for this is not linked to anal sphincter disruption.


Anal Incontinence OASIS Training urinary 


Conflicts of interest



  1. 1.
    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 19:179–183PubMedCrossRefGoogle Scholar
  2. 2.
    Viktrup L (2002) The risk of lower urinary tract sypmptoms five years after the first delivery. Neurourol Urodyn 21(1):2–29PubMedCrossRefGoogle Scholar
  3. 3.
    Fernando R, Sultan AH, Radley S, Jones PW, Johanson RB (2002) Management of obstetric anal sphincter injury: a systematic review and national practice survey. BMC Health Serv Res 2:9PubMedCrossRefGoogle Scholar
  4. 4.
    Wagenius J, Laurin J (2003) Clinical symptoms after anal sphincter rupture: a retrospective study. Acta Obstet Gynecol Scand 82:246–250PubMedCrossRefGoogle Scholar
  5. 5.
    Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36PubMedGoogle Scholar
  6. 6.
    Hagglund D, Wadensten B (2007) Fear of humiliation inhibits women’s care-seeking behaviour for long-term urinary incontinence. Scand J Caring Sci 21:305–312PubMedCrossRefGoogle Scholar
  7. 7.
    Bugg GJ, Kiff ES, Hosker G (2001) A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. Br J Obstet Gynecol 108:1057–1067CrossRefGoogle Scholar
  8. 8.
    Avery K, Donovan JL, Abrams P (2001) Validation of a new questionnaire for incontinence: the international consultation on incontinence questionnaire (ICI-Q). Neurourol Urodyn 20:86Google Scholar
  9. 9.
    Royal College of Obstetricians and Gynaecologists (2007) Third- and fourth-degree perineal tears - management. RCOG Press, London, RCOG Guideline No. 29Google Scholar
  10. 10.
    Andrews V, Thakar R, Sultan AH (2009) Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynaecol J 20:193–199CrossRefGoogle Scholar
  11. 11.
    Thakar R, Sultan AH (2003) Management of obstetric anal sphincter injury. Obstet Gynaecol 5(2):72–78CrossRefGoogle Scholar
  12. 12.
    Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries – myth or reality. Br J Obstet Gynecol 113:195–200CrossRefGoogle Scholar
  13. 13.
    Sander P, Bjarnesen J, Mouritsen L, Fuglsang-Frederiksen A (1999) Anal incontinence after obstetric third-/fourth-degree laceration. One-year follow-up after pelvic floor exercises. Int Urogynecol J 10:177–181CrossRefGoogle Scholar
  14. 14.
    Pinta TM, Kylanpaa ML, Salmi TK et al (2004) Sphincter rupture and anal incontinence after first delivery. Acta Obstet Gynecol Scand 83:917–922PubMedGoogle Scholar
  15. 15.
    Fitzpatrick M, Cassidy M, O’Connell R, O’Herlihy C (2002) Experience with an obstetric perineal clinic. Eur Jour Obstet Gynecol Reprod Biol 100:199–203CrossRefGoogle Scholar
  16. 16.
    Starck M, Bohe M, Valentin L (2006) The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol 27:188–197PubMedCrossRefGoogle Scholar
  17. 17.
    Zetterstrom J, Lopez A, Anzen B, Norman M, Holmstrom B, Mellgren A (1999) Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol 94(1):21–28PubMedCrossRefGoogle Scholar
  18. 18.
    Uustal Fornell EK, Berg G, Hallbook O, Matthiesen LS, Sjodahl R (1996) Clinical consequences of anal sphincter rupture during childbirth. J Am Coll Surg 183:553–558Google Scholar
  19. 19.
    Nazir M, Stein R, Carlsen E et al (2003) Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture misleading. Dis Colon Rectum 46(9):1245–1250PubMedCrossRefGoogle Scholar
  20. 20.
    Tetzschner T, Sorensen M, Ge L et al (1996) Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynecol 103:1034–1040CrossRefGoogle Scholar
  21. 21.
    Otero M, Boulvain M, Bianchi-Demicheli F et al (2006) Women’s health 18 years after rupture of the anal sphincter during childbirth. Urinary incontinence, sexual function, and physical and mental health. Am J Obstet Gynecol 194(5):1260–1265PubMedCrossRefGoogle Scholar
  22. 22.
    Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872PubMedCrossRefGoogle Scholar
  23. 23.
    Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. New Eng J Med 329:1905–1911PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Vasanth Andrews
    • 1
  • Susan Shelmeridine
    • 1
  • Abdul H. Sultan
    • 1
    Email author
  • Ranee Thakar
    • 1
  1. 1.Croydon University HospitalCroydonUK

Personalised recommendations