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Residual defects after repair of obstetric anal sphincter injuries and pelvic floor muscle strength are related to anal incontinence symptoms

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Abstract

Introduction and hypothesis

The aim was to analyze the correlation between residual anal sphincter (AS) defects and pelvic floor muscle (PFM) strength on anal incontinence (AI) in patients with a history of obstetric AS injuries (OASIS).

Methods

From September 2012 to February 2015, an observational study was conducted on a cohort of females who underwent repair of OASIS intrapartum. The degree of OASIS was scored intrapartum according to Sultan’s classification. Participants were assessed at 6 months postpartum. Incontinence symptoms were evaluated using Wexner’s score and PFM strength using the Modified Oxford Scale (MOS). 3D-endoanal ultrasound was performed to classify AS defects according to Starck’s system. Correlation between Sultan’s and Starck’s classifications was calculated using Cohen’s kappa and Spearman’s rho (Rs) test. The impact of residual AS defects and PFM strength on AI was analyzed using a multiple regression model.

Results

A total of 95 women were included in the study. Good correlation (κ= 0.72) was found between Sultan’s and Starck’s classifications. Significant positive correlation was observed between Wexner’s score and both Sultan’s (p = 0.023, Rs =0.212) and Starck’s (p < 0.001, Rs =0.777) scores. The extent of the residual AS defect was the most relevant factor correlating with AI symptoms. In patients with severe AS injuries, higher MOS values were associated with lower Wexner’s score.

Conclusions

The degree of AS tear measured intrapartum was the most important factor related to AI after primary repair of OASIS. PFM strength was associated with lower incontinence symptoms in the postpartum period.

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Acknowledgements

We thank Dr Lluís Aragonès for his contribution in the statistical analysis, and BK Medical-Analogic for loaning our Department the Ultraview-800 equipment.

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Authors and Affiliations

  1. Pelvic Floor Unit, ICGON, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain

    Cristina Ros Cerro, Maria José Palau & Montserrat Espuña-Pons

  2. Pelvic Floor Unit, ICGON, Hospital Clínic, Villarroel 370, 08036, Barcelona, Spain

    Cristina Ros Cerro

  3. Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain

    Eva Martínez Franco

  4. Pelvic Floor Unit, Department of Surgery, Treviso Regional Hospital, Treviso, Italy

    Giulio Aniello Santoro

  5. Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland

    Pawel Wieczorek

Authors
  1. Cristina Ros Cerro
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  2. Eva Martínez Franco
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  3. Giulio Aniello Santoro
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  4. Maria José Palau
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  5. Pawel Wieczorek
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  6. Montserrat Espuña-Pons
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Corresponding author

Correspondence to Cristina Ros Cerro.

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The authors declare that they have no conflicts of interest.

Authors’ participation

Cristina Ros Cerro: project development, manuscript writing; Eva Martinez Franco: data collection, manuscript editing; Giulio Aniello Santoro: data collection, manuscript writing; Maria José Palau: data collection; Pawel Wieczorek: manuscript editing; Montserrat Espuña-Pons: project development, manuscript editing.

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Cerro, C.R., Franco, E.M., Santoro, G.A. et al. Residual defects after repair of obstetric anal sphincter injuries and pelvic floor muscle strength are related to anal incontinence symptoms. Int Urogynecol J 28, 455–460 (2017). https://doi.org/10.1007/s00192-016-3136-z

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  • DOI: https://doi.org/10.1007/s00192-016-3136-z

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