A retrospective review of 1495 patients with obstetric anal sphincter injuries referred for assessment of function and endoanal ultrasonography

Thomas, G. P.; Gould, Leila; Casunuran, F; Kumar, Devinder

doi:10.1007/s00384-017-2851-3

Cited by 16 publications

(10 citation statements)

References 17 publications

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“…It has also been reported that on clinical examination alone, third-and fourth-degree tears are overdiagnosed in the labor ward [13]. In a retrospective review of prospectively collected data over a 10 year period from 1495 patients who had had a primary repair for sphincter injury, Thomas et al [13] found that endoanal ultrasonography demonstrated residual sphincter defect in 792 (53%) and normal sphincters, with no evidence of repair, in 661 (44%) patients. The majority of injuries involved both the external and internal sphincters (n = 501).…”

Section: Assessmentmentioning

confidence: 99%

Fecal incontinence and rectal prolapse

Kumar

2019

Indian J Gastroenterol

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Fecal incontinence is the involuntary loss of flatus, liquid, or solid stool from the anus. It is more common in women than men. The prevalence of fecal incontinence increases with advancing age. It is either idiopathic or due to injury to the sphincter complex. In women, obstetric trauma is the commonest cause of anal sphincter injury leading to incontinence. Other causes include iatrogenic sphincter injury during hemorrhoidectomy and fistula surgery and acute trauma to the perineum. Overt sphincter damage due to third-or fourth-degree vaginal tears during childbirth has been reported in up to 0.7% of all vaginal deliveries resulting in symptomatic fecal incontinence [1, 2]. The pudendal nerve can also be damaged during childbirth trauma resulting in late development of fecal incontinence [3]. Some patients sustain both mechanical and neurological trauma to the sphincter complex [4]. Risk factors associated with sphincter injury include forceps delivery, primiparous mother, birth weight of the baby > 4 kg, and occipito-posterior presentation. A posterolateral episiotomy does not protect against a sphincter tear [5]. Anal endosonography has enabled accurate imaging of the sphincter complex resulting in accurate recognition of occult anal sphincter defects [6-8]. In one study of 62 women with a history of obstetric trauma, endoanal ultrasonography revealed an external anal sphincter defect in 90% and an internal sphincter defect in 65% of patients [9]. In 8 of the 10 women who had a forceps-assisted delivery, there was evidence of sphincter damage. In another study [10], 127 women who had a vaginal delivery underwent endoanal ultrasonography postpartum. Of the 79 primiparous mothers who had intact sphincters before childbirth, 28 showed damage to one or both sphincter muscles following delivery. The extent of the damage to the sphincter complex was

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Section: Assessmentmentioning

confidence: 99%

Fecal incontinence and rectal prolapse

Kumar

2019

Indian J Gastroenterol

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“…Appropriate sensibilization and training of childbirth professionals remains the mainstay for correct detection of OASIS following delivery. A proper detection of these lesions may depend on the experience of the assessor; structured hands-on workshops are important to improve health professionals’ abilities to identify and repair the internal sphincter correctly [ 28 , 29 , 30 ].…”

Section: Diagnosismentioning

confidence: 99%

“…The role of imaging in the early diagnosis of OASIS is further limited by the risk of incorrect interpretation of images and consequent potential overestimation of their occurrence [ 28 , 29 , 32 ]. Indeed, the detection rate of OASIS has significantly increased since the introduction of EAUS in the assessment of the anal sphincter following vaginal delivery (ranging from 11% to 36% of women), but it is unclear whether these findings represent clinically relevant defects [ 33 ].…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

Spinelli

Laurenti

Carrano

et al. 2021

JCM

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Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation.

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“…Moreover, they found comparable Cleveland Clinic Fecal Incontinence scores between patients with or without a sphincter defect diagnosed with EUS. Likewise, Thomas and colleagues did not find a significant difference in Cleveland Clinic FI scores between patients with and without a sphincter defect detected by EUS [13]. Our aim was to investigate whether an association exists between anal sphincter defects detected by EUS and 3D-HRARM, and FI.…”

Section: Introductionmentioning

confidence: 86%

The Outcomes of Endoanal Ultrasound and Three-Dimensional, High-Resolution Anorectal Manometry do not Predict Fecal Incontinence

Trzpis¹

2021

ARGH

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Endoanal ultrasound (EUS) is the gold standard for diagnosing anal sphincter defects often seen in patients with fecal incontinence (FI). Threedimensional, high-resolution anorectal manometry (3D-HRARM) is a newer technique that might also be used to diagnose sphincter defects. We aimed to investigate whether FI is associated with anal sphincter defects detected by EUS and 3D-HRARM. Retrospectively, we included all adult patients who had undergone EUS and 3D-HRARM for FI, between January 2012 and February 2015 (N = 37). During 3D-HRARM, the presence of sphincter defects was examined in rest and during maximal anal sphincter contraction. All patients also underwent a balloon retention test to objectively determine whether they suffered from FI for solid stool. Of the 37 patients, 12 patients (32%) suffered from FI. The presence of a sphincter defect detected with EUS, and with 3D-HRARM during contraction, was not associated with the prevalence of FI and no significant correlations were found between these variables. The presence of a sphincter defect, detected by 3D-HRARM in rest, was negatively correlated with the presence of FI (r s -.372, P = .024). Moreover, the prevalence of sphincter defects was lower in patients with FI, detected by 3D-HRARM in rest, than in patients without FI (13% versus 88%, P = .035). FI is not associated with anal sphincter defects detected by EUS and 3D-HRARM. The outcomes of EUS and 3D-HRARM do not thus predict the presence of FI. Instead, extensive anorectal function tests should be performed to form a complete picture of a patient's anorectal functions and to determine the underlying causes of FI.

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A retrospective review of 1495 patients with obstetric anal sphincter injuries referred for assessment of function and endoanal ultrasonography

Abstract: Third and fourth degree tears appear to be over diagnosed. Primary repair appears to be unsuccessful in the majority of cases. There appears to be poor correlation between objective and subjective assessment of sphincter function.

Cited by 16 publications

References 17 publications

Fecal incontinence and rectal prolapse

Fecal incontinence and rectal prolapse

Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

The Outcomes of Endoanal Ultrasound and Three-Dimensional, High-Resolution Anorectal Manometry do not Predict Fecal Incontinence

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