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Wexner score and quality of life in women with obstetric anal sphincter injury

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Abstract

Introduction and hypothesis

Obstetric anal sphincter injury causes anal incontinence in half of the women affected. However, most symptoms are mild. The objective of this study was to evaluate the prevalence of anal incontinence and quality of life in women at long term after delivery with obstetric anal sphincter injury. We also wanted to identify a relevant cutoff level of the Wexner score (also known as the Cleveland Clinic Incontinence Score) to indicate affected quality of life in these women.

Methods

We performed a population-based questionnaire cohort study with prospective follow-up, including all women in Denmark with obstetric anal sphincter injury and one subsequent delivery between 1997 and 2005. We performed uni- and multivariate analyses and calculated the area under the ROC curve.

Results

In Denmark, 3885 women had an obstetric anal sphincter injury in their first delivery and a second delivery between 1997 and 2005 and no subsequent deliveries until 2010–2011. Questionnaires were sent to 3259 eligible women, and the response rate was 74.6%. In total, 2004 women could be included in the final analyses. Of these, 29.2% (n = 584) reported affected quality of life due to anal incontinence at long-term follow-up. We found that all symptoms of anal incontinence were associated with affected quality of life. The median age at follow-up was 40.3 years.

The area under the ROC curve was 0.96 (95% CI 0.95–0.97) with a sensitivity of 0.94 (95% CI 0.92–0.96) and a specificity of 0.85 (95% CI 0.84–0.87) corresponding to an optimal cutoff level of the Wexner score of ≥ 2 to identify women with affected quality of life due to anal incontinence.

Conclusions

In women with obstetric anal sphincter injury, 29% reported affected quality of life due to anal incontinence at long-term follow-up, and we found a low Wexner score cutoff level of ≥ 2 to identify women with affected quality of life.

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Abbreviations

aOR:

Adjusted odds ratio

AUC:

Area under the curve

CI:

Confidence interval

cOR:

Crude odds ratio

OASIS :

Obstetric anal sphincter injury

ROC:

Receiver-operating characteristics

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Funding

The study was funded by Aase and Ejnar Danielsens Foundation, Denmark. The funding source had no influence or involvement in the study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Herlev Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Hanna Jangö

  2. Department of Obstetrics and Gynecology, Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark

    Jens Langhoff-Roos & Abelone Sakse

  3. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Susanne Rosthøj

Authors
  1. Hanna Jangö
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  2. Jens Langhoff-Roos
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  3. Susanne Rosthøj
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  4. Abelone Sakse
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Contributions

• H Jangö: Design of study, development of questionnaire, data collection, data analysis, writing and critical revision of manuscript.

• J Langhoff-Roos: Design of study, development of questionnaire and critical revision of manuscript.

• S Rosthøj: Data analysis and critical revision of manuscript.

• A Sakse: Design of study, development of questionnaire, data analysis and critical revision of manuscript.

Corresponding author

Correspondence to Hanna Jangö.

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Presentation

Some preliminary data were presented as a podium presentation at the Nordic Urogynecological Associations biannual meeting, Copenhagen, 24–26 January 2019

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Jangö, H., Langhoff-Roos, J., Rosthøj, S. et al. Wexner score and quality of life in women with obstetric anal sphincter injury. Int Urogynecol J 31, 1115–1121 (2020). https://doi.org/10.1007/s00192-019-04134-1

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  • DOI: https://doi.org/10.1007/s00192-019-04134-1

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