Skip to main content
Erschienen in: Archives of Gynecology and Obstetrics 3/2012

01.03.2012 | Maternal-Fetal Medicine

Anal incontinence and quality of life following obstetric anal sphincter injury

verfasst von: Ranitha Kumar

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The objective of our study was to identify the number of women who have long-term ano-rectal symptoms following primary repair of obstetric anal sphincter injury (OASI) and the effect on their quality of life. We also wished to determine the impact of the injury on decision for future pregnancies and mode of delivery in subsequent pregnancies.

Methods

A cohort of women who sustained OASI in 2004 in Ninewells Hospital were contacted (minimum 4 years post-repair). They were sent a questionnaire about incontinence of flatus, solid stools, liquid stools, severity of incontinence, quality of life, decision for future pregnancy and mode of delivery in subsequent pregnancy.

Results

70/4,245 (1.7%) women sustained OASI. 42/70 (60%) women responded to the questionnaire. 15/41 (37%) experienced anal incontinence. 8/15 (53%) women had to alter their lifestyle due to their symptoms. Women who were asymptomatic had a median visual analogue score of 0.5 (range 0–4) and women who were symptomatic had a median score of 3.5 (range 2–8). 12/41 (29%) decided against further pregnancies and 8 of them were symptomatic (p 0.015). 16/41 women (39%) did not have any further pregnancy following OASI and 9 of them (56%) had anal incontinence. Of the 25 women who did have further pregnancies, 6 women (24%) had anal incontinence. 19 of them were asymptomatic. (p = 0.03). 5 out of the 6 symptomatic women had elective caesarean sections.

Conclusions

Long-term outcomes following OASI are not encouraging. A significant number of women decided against further pregnancy and most symptomatic women that have further pregnancy opt to deliver by caesarean section.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
2.
Zurück zum Zitat Third- and Fourth-degree perineal tears (2007) Management RCOG Green Top Guideline number 29. March 2007 Third- and Fourth-degree perineal tears (2007) Management RCOG Green Top Guideline number 29. March 2007
3.
Zurück zum Zitat Thacker SB, Banta HD (1983) Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980. Obstet Gynecol Surv 38:322–338PubMedCrossRef Thacker SB, Banta HD (1983) Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980. Obstet Gynecol Surv 38:322–338PubMedCrossRef
4.
Zurück zum Zitat Pinta TM, Kyalanpaa ML, Salmi TK, Teramo KA (2004) Primary sphincter repair: are the results of the operations good enough? Dis Colon Rectum 47:18–23PubMedCrossRef Pinta TM, Kyalanpaa ML, Salmi TK, Teramo KA (2004) Primary sphincter repair: are the results of the operations good enough? Dis Colon Rectum 47:18–23PubMedCrossRef
5.
Zurück zum Zitat De Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HCS (2001) Risk factors for third degree perineal ruptures during delivery. Br J Obstet Gynaecol 108(4):383–387CrossRef De Leeuw JW, Struijk PC, Vierhout ME, Wallenburg HCS (2001) Risk factors for third degree perineal ruptures during delivery. Br J Obstet Gynaecol 108(4):383–387CrossRef
6.
Zurück zum Zitat Venkatesh KS, Ramanujam PS, Larson DM, Haywood MA (1989) Anorectal complications of vaginal delivery. Dis Colon Rectum 32:1039–1041PubMedCrossRef Venkatesh KS, Ramanujam PS, Larson DM, Haywood MA (1989) Anorectal complications of vaginal delivery. Dis Colon Rectum 32:1039–1041PubMedCrossRef
7.
Zurück zum Zitat Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMedCrossRef Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMedCrossRef
8.
Zurück zum Zitat Donnelly V, Fynes M, Campbell D, Jognson H, O’Connell PR, O’ Herlihy C (1998) Obstetric events leading to anal sphincter damage. Obstet Gynaecol 92:955–961CrossRef Donnelly V, Fynes M, Campbell D, Jognson H, O’Connell PR, O’ Herlihy C (1998) Obstetric events leading to anal sphincter damage. Obstet Gynaecol 92:955–961CrossRef
9.
Zurück zum Zitat Faltin DL, Boulvain M, Irion O, Bretones S, Stan C, Weil A (2000) Diagnosis of anal sphincter tears by postpartum endosonography to predict faecal incontinence. Obstet Gynecol 95:643–647PubMedCrossRef Faltin DL, Boulvain M, Irion O, Bretones S, Stan C, Weil A (2000) Diagnosis of anal sphincter tears by postpartum endosonography to predict faecal incontinence. Obstet Gynecol 95:643–647PubMedCrossRef
10.
Zurück zum Zitat Sultan AH, Kamn MA, Hudson CN, Bartram Cl (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891PubMedCrossRef Sultan AH, Kamn MA, Hudson CN, Bartram Cl (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887–891PubMedCrossRef
11.
Zurück zum Zitat Goffeng AR, Andersch B, Anderson M, Berndtsson I, Hulten L, Oresland T (1998) Objective methods cannot predict anal incontinence after primary repair of extensive anal tears. Acta Obstet Gynaecol Scand 77:439–443CrossRef Goffeng AR, Andersch B, Anderson M, Berndtsson I, Hulten L, Oresland T (1998) Objective methods cannot predict anal incontinence after primary repair of extensive anal tears. Acta Obstet Gynaecol Scand 77:439–443CrossRef
12.
Zurück zum Zitat Fitzpatrick M, Behan M, O’Connell PR, O’ Herlihy C (2000) A randomised clinical trial comparing primary overlap with approximation repair of third degree obstetric tears. Am J Obstet Gynecol 183:1220–1224PubMedCrossRef Fitzpatrick M, Behan M, O’Connell PR, O’ Herlihy C (2000) A randomised clinical trial comparing primary overlap with approximation repair of third degree obstetric tears. Am J Obstet Gynecol 183:1220–1224PubMedCrossRef
13.
Zurück zum Zitat Sangalli MR, Floris L, Faltin D, Weil A (2000) Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynaecol 40(3):244–248PubMedCrossRef Sangalli MR, Floris L, Faltin D, Weil A (2000) Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynaecol 40(3):244–248PubMedCrossRef
14.
Zurück zum Zitat Pretlove S, Thompson PJ, Toozs-Hobson PM, Radley S (2004) The first 18 months of a new perineal trauma clinic. J Obstet Gynaecol 24:399–402PubMedCrossRef Pretlove S, Thompson PJ, Toozs-Hobson PM, Radley S (2004) The first 18 months of a new perineal trauma clinic. J Obstet Gynaecol 24:399–402PubMedCrossRef
15.
Zurück zum Zitat Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrontonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal incontinence quality of life scale: quality of life Instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16 discussion 16-7PubMedCrossRef Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrontonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal incontinence quality of life scale: quality of life Instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16 discussion 16-7PubMedCrossRef
16.
Zurück zum Zitat Haadem K, Ohrlander S, Lingman G (1988) Long term ailments due to anal sphincter rupture caused by delivery—a hidden problem. Eur J Obstet Gynecol Reprod Biol 27:27–32PubMedCrossRef Haadem K, Ohrlander S, Lingman G (1988) Long term ailments due to anal sphincter rupture caused by delivery—a hidden problem. Eur J Obstet Gynecol Reprod Biol 27:27–32PubMedCrossRef
17.
Zurück zum Zitat Crawford LA, Quint EH, Pearl ML, DeLancey JO (1993) Incontinence following rupture of the anal sphincter during delivery. Obstet Gynaecol 1:527–531CrossRef Crawford LA, Quint EH, Pearl ML, DeLancey JO (1993) Incontinence following rupture of the anal sphincter during delivery. Obstet Gynaecol 1:527–531CrossRef
18.
Zurück zum Zitat Poen AC, Felt-Bersma RJ, Strijers RL, Dekker GA, Cuesta MA, Meuwissen SG (1998) Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg 85:1433–1438PubMedCrossRef Poen AC, Felt-Bersma RJ, Strijers RL, Dekker GA, Cuesta MA, Meuwissen SG (1998) Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg 85:1433–1438PubMedCrossRef
19.
Zurück zum Zitat Samarasekera DN, Bekhit MT, Wright Y, Lowndes RH, Stanley KP, Preston JP, Preston P et al (2008) Long-term anal continence and quality of life following postpartum anal sphincter injury. Colorectal Dis 10(8):793–799PubMedCrossRef Samarasekera DN, Bekhit MT, Wright Y, Lowndes RH, Stanley KP, Preston JP, Preston P et al (2008) Long-term anal continence and quality of life following postpartum anal sphincter injury. Colorectal Dis 10(8):793–799PubMedCrossRef
20.
Zurück zum Zitat Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN (2004) Long-term results anterior sphincteroplasty. Dis Colon Rectum 47:727–731PubMedCrossRef Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN (2004) Long-term results anterior sphincteroplasty. Dis Colon Rectum 47:727–731PubMedCrossRef
21.
Zurück zum Zitat Williams A, Lavender T, Richmond MD, Tincello D (2005) Women’s experiences after a third-degree obstetric anal sphincter tear: a qualitative study. Birth 32(2):129–135PubMedCrossRef Williams A, Lavender T, Richmond MD, Tincello D (2005) Women’s experiences after a third-degree obstetric anal sphincter tear: a qualitative study. Birth 32(2):129–135PubMedCrossRef
22.
Zurück zum Zitat Byrd LM, Hobbiss J, Tasker M (2005) Is it possible to predict or prevent or prevent third degree tears? Colorectal Dis 7(4):311–318PubMedCrossRef Byrd LM, Hobbiss J, Tasker M (2005) Is it possible to predict or prevent or prevent third degree tears? Colorectal Dis 7(4):311–318PubMedCrossRef
23.
Zurück zum Zitat Fornell EU, Matthiesen L, Sjodahl R, Berg G (2005) Obstetric anal sphincter injury ten years after: subjective and objective long term effects. Br J Obstet Gynaecol 112(3):312–316CrossRef Fornell EU, Matthiesen L, Sjodahl R, Berg G (2005) Obstetric anal sphincter injury ten years after: subjective and objective long term effects. Br J Obstet Gynaecol 112(3):312–316CrossRef
24.
Zurück zum Zitat Fynes M, Donnelly V, Behan M, O’Conell PR, O’Herlihy C (1999) Effect of second vaginal delivery on anorectal physiology and faecal incontinence: a prospective study. Lancet 354:983–986PubMedCrossRef Fynes M, Donnelly V, Behan M, O’Conell PR, O’Herlihy C (1999) Effect of second vaginal delivery on anorectal physiology and faecal incontinence: a prospective study. Lancet 354:983–986PubMedCrossRef
25.
Zurück zum Zitat de Leeuw JW, Vierhout ME, Struijk PC, Hop WCJ, Wllenburg HCS (2001) Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence. Acta Obstet Gynecol Scand 80:830–834PubMedCrossRef de Leeuw JW, Vierhout ME, Struijk PC, Hop WCJ, Wllenburg HCS (2001) Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence. Acta Obstet Gynecol Scand 80:830–834PubMedCrossRef
26.
Zurück zum Zitat Sultan AH, Thakar R (2002) Lower genital tract, anal sphincter trauma. Best Pract Res Clin Obstet Gynecol 16:99–115CrossRef Sultan AH, Thakar R (2002) Lower genital tract, anal sphincter trauma. Best Pract Res Clin Obstet Gynecol 16:99–115CrossRef
Metadaten
Titel
Anal incontinence and quality of life following obstetric anal sphincter injury
verfasst von
Ranitha Kumar
Publikationsdatum
01.03.2012
Verlag
Springer-Verlag
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 3/2012
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-011-2003-x

Weitere Artikel der Ausgabe 3/2012

Archives of Gynecology and Obstetrics 3/2012 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.