Counseling after perineal laceration: does it improve functional outcome?

Abstract

Anal sphincter laceration is associated with urinary and anorectal incontinence, but symptoms improve or disappear in most cases and are globally not invalidating. Perineal physiotherapy seems to contribute to this positive evolution. Fertility rate among these patients is unaffected, but the CS rate is higher than average. Further consideration of sexual and emotional sequelae could improve our current service.

Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries

“…Pelvic floor injuries after OASI examined with 3D ultrasound are possible predictors for complaints of dyspareunia, anal pain and fecal incontinence. Most previous studies did not evaluate the role of the LAM in fecal incontinence after OASI [10,17,23]. In our cohort fecal incontinence was associated with avulsion of the LAM, a finding similar to a recent publication [28].…”

“…The question is whether the higher morbidity in performing a CS outweighs the benefit of preventing eventual additional damage. Compared with previous studies [10,17] with a reported rate of 3.6-10%, our OASI recurrence rate (4.3%) is within range, but it is still approximately double the index rate of 2.2%.…”

“…After a median follow-up time of 2.7 years after OASI, 48% of patients reported any form of anal incontinence whereas fecal incontinence in solid or liquid form occurred in 4.9% of patients. Our cohort is comparable to groups in earlier studies on this subject, with respect to vertex presentation, OVDs and subdivision between different classifications of OASIs [17]. To our knowledge, this is one of the biggest cohorts of patients that received a recommendation for a subsequent delivery [10].…”

“…Fifty-eight percent of patients had a subsequent VD and 42% of patients delivered by CS, a figure much higher than the overall CS rate of just above 15% in The Netherlands [22]. However, the figure is similar to that of other studies on this subject [17,23]. The question is whether the higher morbidity in performing a CS outweighs the benefit of preventing eventual additional damage.…”

“…A case series by Jordan et al in women who sustained a previous OASI showed no differences in St. Mark's incontinence scores [16] after vaginal delivery (VD) compared with elective cesarean section (CS) when using a standardized protocol to recommend for mode of subsequent delivery [10]. Our hypothesis is that adherence to the parturition mode (PM) recommendation leads to an OASI recurrence rate in line with the experiences of other centers [10,17].…”