Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries

Abstract

We contacted 208 women 13 years after they suffered an obstetrical anal sphincter tear in order to estimate the effect of subsequent vaginal deliveries on anal continence. Among the 177 eligible responders, 129 sustained a partial or complete 3rd degree and 48 a 4th degree tear; 114 women had subsequent vaginal deliveries. Anal incontinence was more common in women with 4th (25.0%) than with 3rd degree tears (11.5%, p = 0.049). Subsequent vaginal deliveries were associated with a higher prevalence of severe incontinence in women with 4th degree tears (p = 0.023). No aggravation or increase in prevalence of incontinence was observed in women with 3rd degree tears. These results suggest that in a subsequent pregnancy, careful evaluation is necessary and an abdominal delivery may be advisable for women with previous major sphincter trauma.

Risk factors for anal sphincter disruption during child birth

“…In the literature, long-term anal incontinence following primary repair of a third-degree tear varies between 15% and 61% [21,22]. In our study, 53% of the women who suffered a third-degree tear (compared to 19% in the control group) complained of anal incontinence.…”

Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis

“…Impact on AI Meta-analysis of five cohort NRSs [13][14][15][16][17] did not demonstrate a significant difference in reported AI in women with previous OASIS who had a subsequent birth, irrespective of mode, compared with those who did not (562 women; OR 1.25; 95% CI 0.73-2.15; I 2 = 36%; Fig. 2).…”

“…Likewise, in their study of women with OASIS and matched controls (mean follow-up 22.2 years), Soerensen et al [19] found no association between long-term AI and having a subsequent birth in women with third-or fourth-degree OASIS. A retrospective cohort study by Sangalli et al [16] reported that subsequent vaginal birth in women who previously sustained third-degree OASIS (n = 80) was associated with a significant decrease in the severity of AI (p = 0.02), whereas for women with previous fourth-degree OASIS (n = 34), subsequent vaginal birth was associated with an increased risk of severe incontinence (p = 0.042). A similar study by Bek and Lauberg [20] found a significant association between transient AI in women directly after sustaining primary Bcomplete^OASIS and permanent AI after a subsequent vaginal birth (OR 8.7; 95% CI 1.9-39; p = 0.05); however, the study sample size was small (n = 56).…”

Perineal techniques during the second stage of labour for reducing perineal trauma

“…Anal sphincter or mucosal injuries are identified following 3% to 4% of all vaginal births. The prevalence of anal incontinence following immediate repair of these third and fourth degree tears ranges between 15% and 59% (Goffeng 1998;Sangalli 2000). The type of suture material used (Kettle 1998), skills of the operator and technique of suturing influence morbidity experience by women (Sultan 2002).…”