Can women with intrapartum rupture of anal sphincter still suffer after‐effects two decades later?

Haadem, Knut; Gudmundsson, Sæmundur

doi:10.3109/00016349709024592

Cited by 52 publications

(45 citation statements)

References 4 publications

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“…Earlier studies have shown that persistent sphincter damage occurs in up to 88% 4–6 and anorectal complaints in up to 50% 5–8 . Only three studies with follow up of more than 15 years comparing faecal incontinence in women with and without anal sphincter damage have been published and have shown contradictory results 8–10 . Nygaard et al found no significant difference between 29 women with obstetric sphincter rupture, 89 women with a midline episiotomy and 33 women delivered by caesarean section, whereas Haadem and Gudmondson described an increased risk of incontinence in 41 women with obstetric sphincter rupture compared with 38 controls.…”

Section: Introductionmentioning

confidence: 99%

Long‐term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints

Mous

Muller

Leeuw

2007

BJOG

114

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Objective To determine the long-term effects of obstetric anal sphincter rupture on the frequency of faecal incontinence and sexual complaints.Design Retrospective case-control study.Setting Department of Gynaecology and Obstetrics, Ikazia Hospital, The Netherlands.Population All 171 women operated for anal sphincter rupture between 1971 and 1990 and 171 controls matched for parity and date of delivery.Methods Postal questionnaires regarding faecal incontinence were sent in 1996 and 2005 to all cases and controls with questions regarding sexual complaints added to the questionnaire in 2005.Main outcome measures Anorectal complaints defined as any form of faecal incontinence including faecal urgency and faecal soiling. Sexual complaints defined as dyspareunia or faecal incontinence during intercourse.Results Sixty-one percent of the women responded to both questionnaires. Anorectal complaints were reported by 38% of case versus 16% of controls in 1996 (risk difference: 0.22, 95% CI 0.10-0.34) and by 61% of cases versus 22% of controls in 2005 (risk difference: 0.41, 95% CI 0.29-0.53). In contrast to the control group, the increase of anorectal complaints in the case group between 1996 and 2005 was highly significant (P < 0.0001). Postmenopausal state was not associated with an increased risk for faecal incontinence. Dyspareunia was reported by 29% of cases versus 13% of controls (P = 0.01). Faecal incontinence during intercourse was reported by 13% of cases versus 1% of controls (P = 0.005).Conclusions Obstetric anal sphincter rupture is an important risk factor for sexual complaints and for faecal incontinence increasing with age irrespective of menopausal state.Keywords Incontinence, sexual complaints, sphincter rupture.Please cite this paper as: Mous M, Muller S, de Leeuw J. Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints. BJOG 2008;115:234-238.

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Section: Introductionmentioning

confidence: 99%

Long‐term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints

Mous

Muller

Leeuw

2007

BJOG

114

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“…Data based on patients' memories are often inaccurate. When questioned 20 years after delivery in a retrospective case-control study, 12% of the women with anal sphincter rupture were unaware that they had sustained such a rupture, and 5% of the controls imagined that they had sustained a rupture [16]. Indeed, the association between the memory of an important perineal tear or a long delivery and subsequent anal incontinence could be related not only to anal sphincter rupture but to another dysfunction in the continence mechanism.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Anal Incontinence and Other Anorectal Symptoms in Women

et al. 2001

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We studied the prevalence of anal incontinence and other anorectal symptoms in women and evaluated the proportion of those who had sought medical help. A structured questionnaire was distributed to 1228 women attending the obstetrics and gynecology outpatient clinics (general, antenatal, urogynecology) of our university hospital. We also screened an additional sample of 984 women, representative of the general population aged 35-74. The prevalence of anal incontinence was 5.6% in the general outpatient clinic, 6.7% in the antenatal clinic, 15.9% in the urogynecology clinic and 4.4% in the general population. Only 20% of women affected by anal incontinence from the general outpatient clinic had reported their symptoms to a medical practitioner. Anal incontinence affects many women, but only a minority seek help. Obstetriciangynecologists should systematically inquire about the presence of this symptom.

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“…Il existe également une association entre périnée complet et dyspareunie [29,30]. À long terme (15 ans et plus), le risque d'incontinence anale ou de dyspareunie est controversé, certaines études cas-témoins retrouvent un risque accru [30,64], tandis que d'autres ne retrouvent plus de lien [65,66].…”

Section: Périnée Complet Et Déchirures Occultesunclassified

Périnée et grossesse

Fritel

2010

Gynécologie Obstétrique & Fertilité

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Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.

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Can women with intrapartum rupture of anal sphincter still suffer after‐effects two decades later?

Abstract: Women with intrapartum anal sphincter rupture can still suffer problems 20 years afterwards. In the follow-up of these women, information and support are essential and active tracing of such women is to be recommended.

Cited by 52 publications

References 4 publications

Long‐term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints

Long‐term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints

Prevalence of Anal Incontinence and Other Anorectal Symptoms in Women

Périnée et grossesse

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