European Journal of Obstetrics & Gynecology and Reproductive Biology
Obstetric anal sphincter injury in the UK and its effect on bowel, bladder and sexual function
Introduction
Obstetric anal sphincter injuries (OASIS) occur in 0.5–9% of vaginal deliveries [1]. Women who have sustained OASIS are more likely to suffer from faecal incontinence than women who have undergone vaginal delivery without OASIS [2]. OASIS are responsible for significant physical, sexual and psychological sequelae [3]. The reported incidence of subsequent symptoms, such as faecal urgency and flatal/faecal incontinence, varies widely, however, from 25% to 67% [4], [5]. As a consequence it is difficult to counsel women accurately and provide relevant prognostic data following such an injury [1], [6]. Furthermore, factors associated with the development of faecal or urinary symptoms following OASIS remain poorly understood. Predicting outcome of primary OASIS repair is problematic due to considerable differences in study design and data collection.
Women who have sustained OASIS require more accurate, up to date information on the likelihood of developing faecal, urinary and sexual symptoms following primary repair. The aim of this study was to determine prospectively the incidence of bowel, urinary and sexual function following OASIS in a large UK Teaching hospital during a five-year period. In addition we identified factors associated with the development of symptoms following OASIS.
Section snippets
Materials and methods
In the five-year period from 2004 to 2009, 435 women who sustained an obstetric anal sphincter injury in Leeds were followed up three months postpartum in the perineal clinic. Details of their bowel, urinary and sexual function were documented using a structured questionnaire. The women had sustained OASIS following a variety of modes of delivery including spontaneous (normal), forceps (rotational and non-rotational) and ventouse deliveries. All sphincter injuries were diagnosed clinically and
Bowel function
Faecal incontinence was reported by 3.7% of women three months following primary OASIS repair (Table 2), but 34.2% reported faecal urgency and 25% suffered from poor control of flatus. Eight percent of women had little or no warning of the need to defaecate and nearly 30% of women reported pain and bleeding on defaecation. Three months after sustaining an obstetric anal sphincter injury 90% of women opened their bowels daily and 91% described the consistency of their motion as normal (Table 2).
Urinary and sexual function
Comments
Although there is good evidence to confirm that OASIS is an important risk factor for faecal and urinary incontinence, the precise impact of OASIS on pelvic floor function is unclear. It is difficult to counsel women regarding their individual risk of developing faecal, urinary or sexual symptoms following OASIS, as considerable variability and discrepancies exist within the literature. This is one of the largest UK studies to report outcome following primary repair of OASIS and also to
Conclusion
Obstetric anal sphincter injuries continue to be responsible for significant morbidity. Although the majority (96%) of women who sustain an obstetric anal sphincter injury are faecally continent three months after delivery, 34% report faecal urgency, 25% report poor flatal control and 30% have pain and bleeding on defaecation. This study reveals that when the anal sphincter is damaged, advancing maternal age and the use of forceps, in particular rotational forceps, significantly increase the
References (25)
- et al.
A randomized clinical trial comparing primary overlap with approximation repair of third degree obstetric tears
Am J Obstet Gynecol
(2000) - et al.
Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques
Am J Obstet Gynecol
(2005) - et al.
Preventing perineal trauma during childbirth: a systematic review
Obstet Gynecol
(2000) - et al.
Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery
Br J Obstet Gynaecol
(2003) - et al.
Occult anal sphincter trauma following randomized forceps and vacuum delivery
Int J Gynecol Obstet
(1998) - et al.
Risk factors for third degree perineal rupture during delivery
BJOG
(2001) - et al.
Anal incontinence in primiparas
JSOGC
(2001) - et al.
Influence of persistent occiput posterior position on delivery outcome
Obstet Gynecol
(2001) - RCOG Green top Guidelines. The management of third and fourth degree perineal tears No 29;...
Faecal and urinary incontinence after vaginal delivery
Am J Obstet Gynaecol
(2003)
Long term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints
BJOG
Third degree anal sphincter tears: risk factor and outcome
Aust N Z J Obstet Gynaecol
Cited by (55)
Impact of obstetric lesions of the levator ani on anal continence
2022, Progres en UrologieObstetric anal sphincter injury events prior and after Episcissors-60 implementation: A systematic review and meta-analysis
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :OASIS may be interchangeably referred to as third- and fourth-degree perineal tears, which involve the anal sphincter, and in severe cases, may extend to the anal mucosa. OASIS represent a principal risk factor of bowel incontinence in parous women in the long term while contributing to short-term morbidity, due to wound breakdown, infection, and perineal pain [2,3]. Overall, OASIS risk may reach up to 6.3 %, of which a 5.7% reflects the risk of OASIS in prims.
Women's experience of obstetric anal sphincter injury following childbirth: An integrated review.
2020, MidwiferyCitation Excerpt :When a woman experiences OASIS following childbirth, an increasingly stressful and complex period ensues (Brown and Lumley 1998; Lee and Gramotnev 2007) with pain and infection contributing to short and long-term morbidity for these women (Bick et al., 2012). Depending on the degree of perineal trauma, it can cause complications such as pain (Andrews et al., 2008), urinary and faecal incontinence (LaCross et al., 2015), sexual dysfunction (Samarasekera et al., 2008; Marsh et al., 2011), anxiety and depression (Desseauve et al., 2016) and can affect a woman's emotional health and day-to-day quality of life (RCOG 2015). These issues can have a negative impact on women's physical, mental and social wellbeing (Tucker et al., 2014) and can negatively affect maternal relationships with their infant, partner and family members (RCOG 2015).
The effects of hands on and hands off/poised techniques on maternal outcomes: A systematic review and meta-analysis
2020, MidwiferyCitation Excerpt :These negative outcomes can lead to both long- and short-term morbidities. Severe perineal trauma may give rise to urinary or anal incontinence, dyspareunia and long-term sexual dysfunction (Stedenfeldt et al., 2014; Jangö et al., 2018; Marsh et al., 2011; OʼShea et al., 2018), while the related perineal pain affects women's daily activities and mood (East et al., 2012). With growing awareness of significant morbidities that perineal trauma brings about, various perineal protective techniques have been tried to promote better maternal outcomes.
Patient's characteristics and incidence of fecal incontinence after primary repair of Obstetric Anal Sphincter Injuries (OASIS) at three Indonesian tertiary hospitals in 2014–2016
2020, European Journal of Obstetrics and Gynecology and Reproductive Biology: XCitation Excerpt :However, not every case of OASIS will result in FI, especially after primary repair of OASIS. FI affects the quality of life and may occur in 3.7%–74% of the population, depending on the characteristics of said population [2,3]. Questionnaires can be used as a tool to assess FI, e.g. the Revised Fecal Incontinence Score (RFIS), which acts as a scoring system to measure the severity of FI [4].
Postpartum Female Sexual Function: Risk Factors for Postpartum Sexual Dysfunction
2020, Sexual Medicine