Incontinence after primary repair of obstetric anal sphincter tears is related to relative length of reconstructed external sphincter: a case–control study

Norderval, Stig; Røssaak, Kristin; Markskog, A.; Vonen, Barthold

doi:10.1002/uog.10154

Cited by 16 publications

(10 citation statements)

References 27 publications

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“…Previous studies suggest that a shorter anal sphincter length following primary repair of OASI is associated with poorer outcomes. 31 In contrast, we found no association between anal sphincter length as measured by way of manometry and post-intervention AI symptoms.…”

Section: Discussioncontrasting

confidence: 77%

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Johannessen

Wibe

Stordahl

et al. 2016

BJOG

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Objective To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI).Design A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity.Setting Ano-rectal specialist out-patient clinics at two hospitals in Norway.Population One hundred and nine postpartum women with AI at baseline. MethodsThe intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind.Main outcome measures The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction.Results There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (À2.1 versus À0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on unimputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did.Conclusions Our results indicate that individually adapted PFME reduces postpartum AI symptoms.

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Section: Discussioncontrasting

confidence: 77%

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Johannessen

Wibe

Stordahl

et al. 2016

BJOG

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“…In addition to the higher Wexner score, the patients in the failed primary repair group had a significantly higher proportion of EAS defects on EAUS. The correlation of Wexner scores with EAUS findings has been shown in past research . This suggests that the Wexner scoring system could be a cost‐effective and potent tool in screening patients who require additional imaging studies of the anal sphincter complex because of a possible occult OASI.…”

Section: Discussionmentioning

confidence: 58%

Factors predicting a failed primary repair of obstetric anal sphincter injury

Kirss

Pinta

Böckelman

et al. 2016

Acta Obstet Gynecol Scand

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“…As these tears typically affect the anterior parts of the sphincters, it was necessary to avoid this possible bias by only assessing women in whom preexisting sphincter defects were highly unlikely. Future studies may explore the extent of the anterior gap and the length of the anterior EAS in both continent and incontinent parous women, as the relative length of the anterior EAS seems to be inversely associated with incontinence at least in women who have sustained obstetric sphincter tears 7 . Finally, the study was undertaken in white women only, and the findings will not necessarily apply to other ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, defects diagnosed by EAUS correlate with findings at reconstructive sphincter surgery 5 . Two different scoring systems have been developed to classify the 3D extent of sphincter defects, 3,6 and studies have shown that larger defects with higher scores are associated with more severe incontinence than smaller defects with lower scores 7–9 . Both scoring systems include partial EAS defects, defined as ultrasound (US) defects involving greater than 50% but less than 100% of the EAS thickness.…”

mentioning

confidence: 99%

“…5 Two different scoring systems have been developed to classify the 3D extent of sphincter defects, 3,6 and studies have shown that larger defects with higher scores are associated with more severe incontinence than smaller defects with lower scores. [7][8][9] Both scoring systems include partial EAS defects, defined as ultrasound (US) defects involving greater than 50% but less than 100% of the EAS thickness. However, the very proximal part of the normal female anterior EAS at the level where it forms a complete muscular ring is thinner than 50% of the lateral and posterior EAS thickness.…”

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confidence: 99%

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Anal Sphincter Length as Determined by 3‐Dimensional Endoanal Ultrasound and Anal Manometry

Norderval

Pedersen

Collinson

2020

J of Ultrasound Medicine

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Objectives The normal female external anal sphincter (EAS) is shorter anteriorly than laterally and posteriorly. Furthermore, the thickness of the very proximal part of the circular EAS is thinner than 50% of the lateral and posterior EAS thickness. The extent of these features is not fully explored. The aim of this prospective study was to assess the normal anal sphincter with 3‐dimensional (3D) endoanal ultrasound (EAUS) and to relate 3D EAUS length measurements to sphincter length determined by anal manometry. Methods Healthy premenopausal nulliparous women underwent anal manometry and 3D EAUS examinations. Two experienced colorectal surgeons independently assessed all scans, blinded to any patient data. Results A total of 43 women were included. Four scans were incomplete and excluded from the analysis. Interobserver agreement was fair to very good for the various length measurements. The mean length from the distal border of the puborectal muscle to the very proximal border of the anterior EAS (the anterior gap) was 4.4 (95% confidence interval, 3.9–4.9) mm, whereas the length to the level where the anterior EAS thickness was at least 50% of the lateral and posterior EAS thickness was 7.2 (95% confidence interval, 6.5–7.9) mm. Manometric sphincter length at rest did not correlate with any 3D EAUS length measurements. Conclusions In the normal anterior female anal canal, the EAS is not present or appears with less than 50% of the thickness of the lateral and posterior EAS for the first 7.2 mm below the distal border of the puborectal muscle.

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Incontinence after primary repair of obstetric anal sphincter tears is related to relative length of reconstructed external sphincter: a case–control study

Abstract: Objective To determine if anatomic primary repair with end-to-end reconstruction of the external anal sphincter (EAS) in its full

Cited by 16 publications

References 27 publications

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Factors predicting a failed primary repair of obstetric anal sphincter injury

Anal Sphincter Length as Determined by 3‐Dimensional Endoanal Ultrasound and Anal Manometry

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