Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Abstract

A study was carried out to identify (1) incidence of anal incontinence symptoms, (2) incidence and size of both external anal sphincter (EAS) and internal anal sphincter (IAS) defects, and (3) relationship between anal incontinence symptoms and IAS or EAS defect size after repair of an obstetric anal sphincter laceration. Forty-seven vaginally primiparous women underwent obstetric anal sphincter laceration repair. At 8-12 weeks postpartum, anal incontinence symptoms were assessed, and endoanal ultrasound was performed. At 1-2 years postpartum, symptoms were reassesseds. The incidence of anal incontinence symptoms at 8-12 weeks was 43%. The incidence of IAS and EAS defects were 32% and 77%, respectively. IAS defects > or = 45 degrees were predictive of symptoms (p = 0.02). After 18 months mean follow-up, 11% reported chronic symptoms. After anal sphincter laceration repair, anal incontinence symptoms occur in 43% of women and remain chronic in 11%. Anal incontinence symptoms are associated with increasing IAS defect size.

A questionnaire on pelvic floor dysfunction postpartum

“…It has been shown that anal incontinence after delivery is associated with increasing size of the internal anal sphincter defect [30, 31]. In our study, leakage of liquid stools occurred rather frequently in both groups 1 and 2 (17.7% and 17.0%, respectively) but also occurred among women delivered vaginally with no known OASIS.…”

Long-Term Effects on Pressure and Electromyography in a Rat Model of Anal Sphincter Injury

“…Results in the first week after sphincterotomy revealed a decreased number of peaks, indicating that damaged muscle fibers had lost the ability to contract. 29,30 However, contrary to what happens in a clinical setting, in this model the pressures gradually return to near-normal levels over time as the process of tissue repair progresses.…”

Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery

“…Tears in the connective and muscular tissue as well as compression of the vascular supply and nerve bundles represent direct and indirect trauma responsible for defects in pelvic organ support and functional alterations of surrounding organs. A thirddegree tear increases the risk of fecal incontinence [4][5][6], although long-term results are conflicting [7,8]. Nygard et al found a large number of fecal incontinence in middleaged women, without statistical differences between the episiotomy, anal sphincter tear, or Caesarean groups [8].…”