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Can ultrasound 10 days after obstetric anal sphincter injury predict anal incontinence at long-term follow-up?


Introduction and hypothesis

The objective was to investigate whether endoanal ultrasound (EAUS) performed 10 days after a primary repaired obstetric anal sphincter injury (OASIS) can predict the severity of anal incontinence (AI) in the long term.


This prospective cohort study included women with a primary repaired 3b-degree tear, 3c-degree tear or fourth-degree tear at Aarhus University Hospital, Denmark, from 1 September 2010 to 31 May 2011. Clinical assessment and EAUS were performed on day 2, day 10, and day 20 after delivery. Functional outcomes were assessed using a questionnaire at the time of all clinical visits and at the long-term follow-up, 7 years after delivery. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score.


Ninety-six out of 99 women consented to participate. Five women had a secondary sphincter repair and were subsequently excluded from follow-up. Fifty-seven women underwent both EAUS 10 days after delivery and answered the long-term follow-up questionnaire. Median follow-up time was 7.7 years (IQR 7.4–7.8). Mean Wexner score was 4.4 ± 4.8 10 days after delivery and 2.5 ± 2.8 at follow-up; thus, the Wexner score improved over time (p = 0.01). Ultrasound sphincter defects were found in 82.6% of the women. Mean Starck score was 3.0 ± 1.8. The risk of AI was 0% (95% CI 0.0–30.8) if the Starck score was 0. No correlation was found between the Starck score and the Wexner score at follow-up.


We found that performing EAUS in the puerperium following OASIS has limited value in predicting long-term AI.

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Author information




M. Barbosa: project development, data collection, data analysis, manuscript writing; P. Christensen: project development, manuscript writing; K. Møller-Bek: data collection, manuscript writing; L. Brogaard: data analysis, manuscript writing; Marianne Glavind-Kristensen: project development, data collection, manuscript writing.

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Correspondence to Malou Barbosa.

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Barbosa, M., Christensen, P., Møller-Bek, K. et al. Can ultrasound 10 days after obstetric anal sphincter injury predict anal incontinence at long-term follow-up?. Int Urogynecol J 32, 2511–2520 (2021).

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  • Obstetric sphincter injury
  • Anal sphincter
  • Anal incontinence
  • Anal ultrasound
  • EAUS