Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study

Fynes, Michelle; Donnelly, V.; Behan, Michael; O'Connell, P. R.; O’Herlihy, Colm

doi:10.1016/s0140-6736(98)11205-9

Cited by 260 publications

(155 citation statements)

References 20 publications

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“…Although some reports [17,18] suggested that there was no correlation between age and postoperative function, another concluded that failure rates were higher with increasing age [13] . Pudendal nerve terminal motor latency (PNTML) was considered to be an important factor in determining the poor outcome of overlapping sphincter repair, which was recognized by Tjandra et al [10] in their series [19][20][21] . However, other studies [13,14] noted that PNTML might not be sensitive enough to detect nerve damage, and PNTML time was delayed for each woman even after the first vaginal delivery [21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

“…Pudendal nerve terminal motor latency (PNTML) was considered to be an important factor in determining the poor outcome of overlapping sphincter repair, which was recognized by Tjandra et al [10] in their series [19][20][21] . However, other studies [13,14] noted that PNTML might not be sensitive enough to detect nerve damage, and PNTML time was delayed for each woman even after the first vaginal delivery [21][22][23] . Tetzschner et al [24] report that reliability of PNTML depended on several factors such as the measurements performed, time of day, and side of the nerve used.…”

Section: Discussionmentioning

confidence: 99%

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Overlapping Repair in Patients with Anal Sphincter Injury

Demirbaş

Atay²,

Sücüllü³

et al. 2008

Med Princ Pract

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Objective: The aim of this study was to demonstrate the improvement of anal canal function after overlap sphincter repair and confirm that this treatment option is superior in patients with nonobstetric sphincter damage. Subjects and Methods: From 1998 to 2003, 44 women who underwent overlapping sphincter repair were enrolled in this study. The women were allocated to one of two groups, obstetric trauma (n = 31) and nonobstetric (perineal) trauma (n = 13). Both groups were compared in terms of age, operation time, number of deliveries, hospital stay, need for analgesics, complication rate, pre- and postoperative outcomes of anal manometry and quality of life, using the fecal incontinence severity index and a questionnaire for fecal disorders. Results: Anal canal length was significantly extended postoperatively in both groups compared to preoperative length. Eight-week postoperative resting and squeeze pressures were significantly higher than preoperative pressures in both patients with nonobstetric and obstetric sphincter injury. Although significant increase was seen in both groups, the mean postoperative resting and squeeze pressures at 1 year were rather high in patients with nonobstetric sphincter injury. At the end of a year of follow-up, overall satisfaction of the repair was about 82%. Conclusion: Overlap sphincter repair was feasible, although patient satisfaction was slightly less in the obstetric than in the nonobstetric trauma group. The improvement of anal function at 20- to 24-month follow-up is attributed to both high squeeze pressure and broad anal canal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Overlapping Repair in Patients with Anal Sphincter Injury

Demirbaş

Atay²,

Sücüllü³

et al. 2008

Med Princ Pract

View full text Add to dashboard Cite

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“…Les forceps et les déchirures du périnée sont alors les principaux facteurs de risques d'incontinence anale [14,8,16]. Par ailleurs, il semble que les premiers accouchements soient les plus traumatiques avec une incontinence anale qui survient dans 40 % des cas après un 2 e accouchement par voie basse s'il y avait une rupture sphinctérienne après le 1 er accouchement [19,20]. Cependant, il y a également une sommation des altérations du périnée avec la succession des accouchements pouvant aboutir à une incontinence définitive au long cours [10,21].…”

Section: Accouchementunclassified

Épidémiologie et facteurs de risque de l’incontinence anale

Abramowitz

2013

Incontinence Anale De L’adulte

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DéfinitionsLe terme incontinence n'est pas spécifique, il peut exprimer l'incapacité à retenir les selles ou les urines. L'incontinence fécale est l'incapacité à retenir les matières (solides et/ou liquides) avec l'anus et l'incontinence anale (IA) est plus générale, y associant l'incapacité à retenir les gaz. On distingue également l'incontinence active et passive. La première implique que le patient a ressenti un besoin mais qu'il n'a pu se retenir, alors que l'incontinence passive est une perte sans besoin préalable. Le seuil de fréquence des pertes involontaires pour classer un patient dans la catégorie « incontinent » ne fait pas consensus : un patient est-il incontinent dès qu'il perd au moins un gaz par an, par mois, par semaine ou par jour ? La réponse n'est pas si évi-dente et est diversement tranchée selon les études, d'autant que le retentissement est très variable selon la vie et le travail des patients. Une perte de gaz occasionnelle sera vécue très difficilement par une personne ayant un métier de relation, alors qu'elle pourra être très bien tolérée chez quelqu'un travaillant chez soi ou en plein air. Enfin, en dehors de la perte de gaz ou de selles stricto sensu, la notion de suintements anaux est une réalité parfois aussi très invalidante pour les patients. Toutes ces définitions montrent la diversité des incontinences pouvant expliquer une partie des variations des données épidémiologiques. Depuis peu, certaines études essayent de s'approcher de la réalité du ressenti des patients en leur demandant par exemple (si possible par autoquestionnaire) s'ils se sentent incontinents, ou le nombre de jours sans fuite. L. Abramowitz ( ) -Unité de proctologie

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“…With regard to the mode of delivery in the case of persistent anal incontinence after a first vaginal delivery, Fynes and colleagues published important data [18]. They examined the effects of first and second vaginal deliveries on anal physiology and continence in 59 previously nulliparous women.…”

Section: Prevention Of Anal Incontinencementioning

confidence: 99%