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


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.


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.


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).


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.


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


Source of funding

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

Conflict of interest



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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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