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International Urogynecology Journal

, Volume 25, Issue 5, pp 607–613 | Cite as

Fecal incontinence, sexual complaints, and anorectal function after third-degree obstetric anal sphincter injury (OASI): 5-year follow-up

  • A. P. Visscher
  • T. J. Lam
  • N. Hart
  • R. J. F. Felt-Bersma
Original Article

Abstract

Introduction and hypothesis

Our aim was to evaluate alterations in anorectal function after anal sphincteroplasty for third-degree obstetric anal sphincter injury (OASI) in relation to clinical outcome.

Methods

In this retrospective, descriptive, cross-sectional study conducted between 1998 and 2008, women with persisting fecal incontinence (FI) after 3a OASI and all women with grade 3b or 3c OASI were sent for anorectal function evaluation (AFE) consisting of anal manometry and endosonography 3 months after sphincteroplasty. In 2011, questionnaires regarding FI (Vaizey/Wexner), urinary incontinence (UI) [International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF)], sexual function [Female Sexual Function Index (FSFI)], and quality of life (QOL) (Rand-36) were sent and women were asked to undergo additional AFE.

Results

Sixty-six women underwent AFE. Mean follow-up was 5.0 years. Forty (61 %) patients returned questionnaires regarding FI and UI. Prevalence of FI was 63 % flatus, 50 % liquid stool, and 20 % solid stool. Thirty-two of 40 also reported on QOL and SF. Sexual dysfunction was present in the majority of women (cutoff value 26.55) and more pronounced in larger OASI. Sixteen of 40 women underwent additional AFE. Women with combined internal (IAS) and external (EAS) anal sphincter injury (n = 6) had worse FI (P < 0.050) and lower anal pressures (P = 0.040) than women with isolated EAS injury (n = 10).

Conclusion

Follow-up after third-degree OASI suggests poor anorectal and sexual function. Women with combined external and internal OASI show more deterioration in anorectal function and experience worse FI. Therefore, special attention should be paid to these women in order to mitigate these symptoms later in life.

Keywords

Fecal incontinence Third-degree obstetric anal sphincter rupture OASI Anal manometry Sexual dysfunction Anal endosonography 

Notes

Source of funding

Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands

Conflict of interest

None.

References

  1. 1.
    Chatoor DR, Taylor SJ, Cohen CR, Emmanuel AV (2007) Faecal incontinence. Br J Surg 94(2):134–144PubMedCrossRefGoogle Scholar
  2. 2.
    Tetzschner T, Sorensen M, Lose G, Christiansen J (1998) Anal and urinary incontinence after obstetric anal sphincter rupture. Ugeskr Laeger 160(22):3218–3222PubMedGoogle Scholar
  3. 3.
    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(2):188–197PubMedCrossRefGoogle Scholar
  4. 4.
    Nazir M, Carlsen E, Jacobsen AF, Nesheim BI (2002) Is there any correlation between objective anal testing, rupture grade, and bowel symptoms after primary repair of obstetric anal sphincter rupture?: an observational cohort study. Dis Colon Rectum 45(10):1325–1331PubMedCrossRefGoogle Scholar
  5. 5.
    Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91(1):33–36PubMedGoogle Scholar
  6. 6.
    Glasgow SC, Lowry AC (2012) Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum 55(4):482–490PubMedCrossRefGoogle Scholar
  7. 7.
    Browning GG, Motson RW (1983) Results of Parks operation for faecal incontinence after anal sphincter injury. Br Med J (Clin Res Ed) 286(6381):1873–1875CrossRefGoogle Scholar
  8. 8.
    Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44(1):77–80PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97PubMedCrossRefGoogle Scholar
  10. 10.
    Klovning A, Avery K, Sandvik H, Hunskaar S (2009) Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn 28(5):411–415PubMedCrossRefGoogle Scholar
  11. 11.
    Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208PubMedCrossRefGoogle Scholar
  12. 12.
    Derogatis LR, Rosen R, Leiblum S, Burnett A, Heiman J (2002) The Female Sexual Distress Scale (FSDS): initial validation of a standardized scale for assessment of sexually related personal distress in women. J Sex Marital Ther 28(4):317–330PubMedCrossRefGoogle Scholar
  13. 13.
    ter Kuile MM, Brauer M, Laan E (2006) The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): psychometric properties within a Dutch population. J Sex Marital Ther 32(4):289–304PubMedCrossRefGoogle Scholar
  14. 14.
    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):1–20PubMedCrossRefGoogle Scholar
  15. 15.
    Van der Zee KL, Sanderman R. Het meten van de algemene gezondheidstoestand met de Rand-36, een handleiding. Research institute SHARE, UMCG/Rijksuniversiteit Groningen. Centrum voor gezondheidsvraagstukkenGoogle Scholar
  16. 16.
    Wohlrab KJ, Rardin CR (2008) Impact of route of delivery on continence and sexual function. Clin Perinatol 35(3):583–90, xiiPubMedCrossRefGoogle Scholar
  17. 17.
    Wagenius J, Laurin J (2003) Clinical symptoms after anal sphincter rupture: a retrospective study. Acta Obstet Gynecol Scand 82(3):246–250PubMedCrossRefGoogle Scholar
  18. 18.
    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(2):234–238PubMedCrossRefGoogle Scholar
  19. 19.
    Pauls RN, Silva WA, Rooney CM et al (2007) Sexual function following anal sphincteroplasty for fecal incontinence. Am J Obstet Gynecol 197(6):618–6PubMedGoogle Scholar
  20. 20.
    Dudding TC, Vaizey CJ, Kamm MA (2008) Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 247(2):224–237PubMedCrossRefGoogle Scholar
  21. 21.
    Walsh CJ, Mooney EF, Upton GJ, Motson RW (1996) Incidence of third-degree perineal tears in labour and outcome after primary repair. Br J Surg 83(2):218–221PubMedCrossRefGoogle Scholar
  22. 22.
    Roos AM, Thakar R, Sultan AH (2010) Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol 36(3):368–374PubMedCrossRefGoogle Scholar
  23. 23.
    Zetterstrom JP, Lopez A, Anzen B, Dolk A, Norman M, Mellgren A (1999) Anal incontinence after vaginal delivery: a prospective study in primiparous women. Br J Obstet Gynaecol 106(4):324–330PubMedCrossRefGoogle Scholar
  24. 24.
    Palm A, Israelsson L, Bolin M, Danielsson I (2012). Symptoms after obstetric sphincter injuries have little effect on quality of life. Acta Obstet Gynecol Scand 92(1):109–115Google Scholar
  25. 25.
    Tetzschner T, Sorensen M, Lose G, Christiansen J (1996) Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol 103(10):1034–1040PubMedCrossRefGoogle Scholar
  26. 26.
    Otero M, Boulvain M, Bianchi-Demicheli F et al (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(5):1260–1265PubMedCrossRefGoogle Scholar
  27. 27.
    Felt-Bersma RJ (2004) Endosonographic imaging of the anal sphincter: the size of the tear does matter. Dis Colon Rectum 47(4):546–547PubMedCrossRefGoogle Scholar
  28. 28.
    Poen AC, Felt-Bersma RJ (1999) Endosonography in benign anorectal disease: an overview. Scand J Gastroenterol Suppl 230:40–48PubMedGoogle Scholar
  29. 29.
    Jameson JS, Chia YW, Kamm MA, Speakman CT, Chye YH, Henry MM (1994) Effect of age, sex and parity on anorectal function. Br J Surg 81(11):1689–1692PubMedCrossRefGoogle Scholar
  30. 30.
    Fox JC, Fletcher JG, Zinsmeister AR, Seide B, Riederer SJ, Bharucha AE (2006) Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 49(11):1726–1735PubMedCrossRefGoogle Scholar
  31. 31.
    Samarasekera DN, Bekhit MT, Wright Y et al (2008) Long-term anal continence and quality of life following postpartum anal sphincter injury. Colorectal Dis 10(8):793–799PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • A. P. Visscher
    • 1
  • T. J. Lam
    • 1
  • N. Hart
    • 1
  • R. J. F. Felt-Bersma
    • 1
  1. 1.Department of Gastroenterology and HepatologyVU University Medical CenterAmsterdamThe Netherlands

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