Introduction and hypothesisOur primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit’s standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology.MethodsThis is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark’s Incontinence Score (SMIS), anal manometry and EAUS at both antepartum and 3-month postpartum visits. Data were analysed using Wilcoxon and Mann–Whitney U tests.ResultsThree hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p < 0.001). There were no new defects on EAUS in either group.ConclusionsThis study showed no significant worsening of bowel symptoms and sphincter integrity apart from lower squeeze pressures at 3 months postpartum in the VD group when our standardised protocol was used to recommend subsequent mode of delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.

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0.6-5.0), after 2 treatments by 3cm from baseline (range 0.7-6.1cm) and at follow up by 3.8cm (range 0-8.7). Two patients experienced serious complications. One who had chronic lymphocytic leukaemia developed septicaemia and pneumonia the following day. The organism responsible was not a bowel organism. The other developed an anterior rectal wall fistula in an area of intense radiation change requiring surgery 18 months later. Neither complication was considered to be caused by the formalin. Conclusion 67% patients with radiation-induced rectal bleeding experience a satisfactory reduction in bleeding following treatment with intra-rectal formalin. Further studies comparing with other treatment modalities are required. Introduction Faecal incontinence and urgency are well-recognised sequelae of obstetric injury, however there is a paucity of literature describing the co-existence of symptoms of rectal evacuatory dysfunction (RED) and faecal incontinence (FI). This study aims to analyse and quantify these symptoms in patients referred for anorectal investigations following obstetric injury. Methods Consecutive patients undergoing specialist investigation at a tertiary referral unit following obstetric injury between 1 st July 2010 and 31 st July 2012 were identified. Symptoms at presentation were ascertained from the history. Patients routinely complete a Cleveland Clinic Constipation Score (CCCS) and Vaizey Incontinence score (VIS) prior to investigation. Symptoms volunteered by the patient were correlated with formal scoring systems to verify accuracy of symptom reporting and to study the co-existence of FI and RED. Results One hundred and sixty five women [median age 34 (range 19-55)] were included. Median parity was 2 [range 1-8]. Fourteen women (9.7%) had a 4th degree tear and 68 women (41%) a 3 rd degree tear [106 (64%) occurring from the first vaginal delivery]. Three women requiring de-functioning stoma were excluded from further analysis. Disclosure of InterestFI was volunteered in 87 women (54%), [59 urge FI (36%), 57 passive FI (35%) and 28 mixed FI (17%)]. Ninety women (56%) volunteered symptoms of RED. Co-existent symptoms of RED and FI were present in 58 women (36%).VIS and CCCS were available for 79 patients. Median VIS was 8 (IQR 4-13), and was significantly higher in those reporting FI symptoms [median score 11 (IQR 8-15)] than those not [median score 4 (IQR 0-8)] (p < 0.0001 Mann Whitney U Test). Median CCCS was 8 (IQR 4-14), which was significantly higher in those reporting RED symptoms [median score 13 (IQR 11-17)] than those not [median score 5 (IQR 3-8)] (p < 0.0001 Mann Whitney U Test). Fifty four patients (68%) had significant FI based on VIS (score > 5) and 39 patients (49%) had significant RED based on CCCS (score > 8). Thirty patients (38%) had scores compatible with significant co-existent FI and RED. Conclusion These results demonstrate symptoms of FI and RED often co-exist following obstetric injury regardless of method used to ascertain symptoms. A multi-modality treatment approach a...

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