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Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term?

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Abstract

Background

Obstetric anal sphincter injury is the most frequent cause of fecal incontinence (FI) in young women. However, the relationship between the extent of anal sphincter defects and the severity of long-term FI (at least 1 year after delivery) has been poorly studied. The aim of the present study was to determine if, in the long term, the extent of anal sphincter defects graded at anal endosonography was linked with the severity of FI.

Methods

A retrospective study was conducted on women with a history of vaginal delivery, who presented with FI and had three-dimensional anorectal high-resolution manometry and endoanal ultrasound in our center from January 2015 to 2016. The detailed clinical history of each patient was obtained from the institutional database. The severity of FI was assessed with the Jorge and Wexner continence scale.

Results

There were 250 women with a mean age of 60 ± 14 years. Seventy-six (30.4%) had an isolated defect of the internal anal sphincter, 21 (8.4%) had an isolated defect of the external anal sphincter, and 150 (60%) had both internal and external sphincter defects. The extent of IAS and EAS defects was proportionally correlated with the decrease in mean resting anal pressure (p < 0.01) and the decrease in mean squeeze pressure (p = 0.013) measured by 3DHRAM. No significant correlation was found between the extent and location of the defect (IAS, EAS or both) on endoanal ultrasound and the severity of FI. Menopause was the only independent factor significantly associated with the severity of FI.

Conclusions

In our study, no significant correlation was observed between the extent of the anal sphincter defect and the severity of FI. Menopause was the only identified and independent risk factor for FI. These data confirm that, in the long-term, FI is often multifactorial.

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Funding

The authors declare that they have no funding source.

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Authors and Affiliations

  1. Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France

    L. Luciano

  2. Department of Gastroenterology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France

    M. Bouvier & V. Vitton

  3. EA3279 Self-perceived Health Assessment Research Unit, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France

    K. Baumstarck

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  1. L. Luciano
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  2. M. Bouvier
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  3. K. Baumstarck
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  4. V. Vitton
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Correspondence to L. Luciano.

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For this type of study (retrospective) formal consent is not required.

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This is a retrospective study and according to French legislation on clinical trials at the time of the study, there was no need for patient consent. The data used were anonymized and collected from the APHM computer file which is declared to the Commission Nationale Informatique et Liberté (French National Commission for Data Protection).

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Luciano, L., Bouvier, M., Baumstarck, K. et al. Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term?. Tech Coloproctol 24, 49–55 (2020). https://doi.org/10.1007/s10151-019-02128-1

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  • DOI: https://doi.org/10.1007/s10151-019-02128-1

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