Obstetric anal sphincter injury: a follow-up questionnaire study on longer-term outcomes
- 463 Downloads
Introduction and hypothesis
Obstetric anal sphincter injuries (OASIS) contribute significantly to the development of anal incontinence (AI) in women. The aim of this study was to establish the incidence of AI after OASIS and to study the influence on the quality of life (QoL) in patients with OASIS.
This cohort study, with prospective case-control follow-up, involves women who were treated for OASIS between 2005 and 2012 in two academic medical centers in The Netherlands. Three hundred and thirteen patients and 780 controls were invited to complete a validated questionnaire (Defecation Distress Inventory, Wexner Incontinence Score, and Fecal Instrument Quality of Life) regarding symptoms and bother of AI subsequent and QoL after delivery. The main outcome measures were the presence of AI and the impact on QoL.
The questionnaire was completed by 141 patients and 194 controls. Mean follow-up was 4 years (range 1–9 years) in both groups. In the patient group, 55 women (39 %) reported AI symptoms compared with 38 women (20 %) in the control group (odds ratio 2.7, 95 % confidence interval 1.66–4.47, p < 0.01). In women who experienced symptoms of AI as very bothersome, QoL was affected in 14 (82.0 %) patients and three (33.5 %) controls (p = 0.012).
In this study, women with OASIS had a more than doubled risk of longer-term bothersome symptoms of AI compared with controls. Symptoms were experienced as bothersome and as having an influence on QoL.
KeywordsAnal incontinence Follow-up Obstetric anal sphincter injury Quality of life
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Details of ethics approval
Ethics approval was obtained from the Medical Ethics Board form the Maastricht University Medical Centre on 06-06-2014 (REB number:14-02-002)
The Medical Ethics board of the Radboud University Nijmegen Medical Centre, gave approval to the study design without submission of the protocol.
- 1.Nederland Stichting Perinatale Registratie. (Dutch foundation of Perinatal Registry) Perinatale Zorg in Nederland 2013. http://www.perinatreg.nl/uploads/150/153/PRN_jaarboek_2013_09122014.pdf Accessed 1 feburary 2015
- 2.Richtlijn. Totaalruptuur 2013. (Guideline of obstetric anal sphincter injury). Nederlandse Vereniging voor Obstetrie en Gynaecologie 2013. http://richtlijnendatabase.nl/richtlijn/totaalruptuur/risicofactoren_en_preventie_van_totaalruptuur.html Accessed 1 july 2015
- 8.RCOG. The management of third- and fourth-degree perineal tears. Green-Top Guideline No. 29 2007 https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg29/?_t_id=1B2M2Y8AsgTpgAmY7PhCfg%3d%3d&_t_q=anal&_t_tags=language%3aen%2csiteid%3a39338ee9-cb61-4e10-a686-8f4a5e1b76d7&_t_ip=184.108.40.206&_t_hit.id=EPiServer_Templates_RCOG_Models_Pages_GuidelinesDetailsType/_ca45d3c4-23cb-461b-8d30-4aad40ef6ffd_en&_t_hit.pos=2 Accessed 1 july 2015
- 13.Sultan AH (1999) Editorial: obstetric perineal injury and anal incontinence. Clin Risk 5:193–196Google Scholar