Abstract
Introduction and hypothesis
The primary objective of this study was to determine the prevalence of anal incontinence (AI) in post-partum women following obstetrical anal sphincter injury (OASI). We also assessed quality of life and prevalence of other pelvic floor symptoms.
Methods
Women who had third or fourth degree OASI were asked to complete the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).
Results
Survey response rate was 25% (n = 1,383). Average patient age was 33.4 years. Of the patients, 10.2% had a fourth degree tear, and 89.8% had a third degree tear. Prevalence of AI was 7.7% (formed stool), 19.7% (loose stool), and 38.2% (flatus). Average PFDI and PFIQ scores were significantly higher in the fourth degree tear group.
Conclusions
The community prevalence and impact of AI have not been well-studied. Establishment of a perineal clinic and an increase in resources may help educate women and expedite treatment for OASI.
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References
Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891
Royal College of Obstetricians and Gynaecologists (2007) The management of third- and fourth-degree perineal tears. RCOG Press, London, RCOG Guideline No. 29
Lewicky-Gaupp C, Hamilton Q, Ashton-Miller J, Huebner M, DeLancey JOL, Fenner DE (2009) Anal sphincter structure and function relationships in aging and fecal incontinence. Am J Obstet Gynecol 200:559, e1-559.e5
Lahr CJ (1988) Evaluation and treatment of incontinence. Pract Gastroenterol 12:27–35
Jorge JMN, Wexner SD (1993) A practical guide to basic anorectal physiology investigations. Contemp Surg 43:214–224
Faltin DL, Sangalli MR, Curtin F, Morabia A, Weil A (2001) Prevalence of anal incontinence and other anorectal symptoms in women. Int Urogynecol J 12:117–121
Snooks SJ, Swash M, Henry MM, Setchell M (1985) Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorect Dis 72(Suppl):S15–7
Oberwalder M, Connor J, Wexner SD (2003) Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 90:1333–1337
Poen AC, Felt-Bersma JF, Strijers RLM, Dekkers GA, Cuesta MA, Meuwissen SGM (1998) Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg 85:1433–1438
Faltin DL, Sangalli MR, Roche B, Floris L, Boulvain M, Weil A (2001) Does a second delivery increase the risk of anal incontinence? Br J Obstet Gynaecol 108:684–688
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911
Signorello LB, Harlow BL, Chekos AK, Repke JT (2000) Midline episiotomy and anal incontinence: Retrospective Cohort Study. BMJ 230:7227–86
Eason E, Labrecque M, Marcoux S, Mondor M (2002) Anal incontinence after childbirth. CMAJ 166(3):326–30
Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Grynecol 193(1):103–113
Fornell EU, Matthiesen L, Sjodahl R, Berg G (2004) Obstetric anal sphincter injury ten years after: subjective and objective long-term effects. BJOG:Int J Obs Gynecol 112:312–316
Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JOL (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1550
Wohlrab KJ, Rardin CR (2008) Impact of route of delivery on continence and sexual function. Clin Perinatol 35:583–590
Samarasekera DN, Bekhit MT, Wright Y, Lowndes RH, Stanley KP, Preston JP, Preston P, Speakman CTM (2008) Long-term anal continence and quality of life following postpartum anal sphincter injury. Colorectal Dis 10:793–799
Mahony R, Behan M, Daly L, Kirwin C, O’Herlihy C, O’Connell PR (2007) Internal anal sphincter defect influences continence outcome following obstetrical anal sphincter injury. Am J Obstet Gynecol 196(217):e1–e5
Vaccaro C, Clemons J (2008) Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women. Int Urogynecol J 19:1503–1508
Kenton K, Brincat C, Mutone M, Brubaker L (2005) Repeat Cesarean section and primary elective Cesarean section: recently trained obstetrician-gynecologist practice patterns and opinions. Am J Obstet Gynecol 192:1872–1876
FitzGerald MP, Janz NK, Wren PA, Wei JT, Weber AM, Ghetti C, Cundiff GW (2007) Prolapse severity, symptoms and impact on quality of life among women planning sacrcolpopexy. Int J Gynaecol Obstet 98:24–28
Mayday Urogynaecology Unit. Surrey, UK: Mayday Urogynaecology and Pelvic Floor Reconstruction Unit. Available from http://www.perineum.net. Accessed on9 Mar 2007.
Conflicts of interest
Dr. Schulz is a paid consultant for Gynecare, Astellas, Triton, and Pfizer and is doing research studies for Gynecare and Astellas. Dr. Flood is doing research studies for Gynecare and Astellas.
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Rainbow Tin was support by the Northern Alberta Clinical Trials Centre and the Urogynecology Clinic Research Fund.
Dr. Rosychuk was supported by the Alberta Heritage Foundation for Medical Research (AHFMR; Edmonton) as a Health Scholar.
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Tin, R.Y.T., Schulz, J., Gunn, B. et al. The prevalence of anal incontinence in post-partum women following obstetrical anal sphincter injury. Int Urogynecol J 21, 927–932 (2010). https://doi.org/10.1007/s00192-010-1134-0
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DOI: https://doi.org/10.1007/s00192-010-1134-0