Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term?

Luciano, Laure; Bouvier, Michel; Baumstarck, Karine; Vitton, Véronique

doi:10.1007/s10151-019-02128-1

Cited by 12 publications

(8 citation statements)

References 45 publications

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“…In keeping with the present study findings, the severity of anal sphincter injury defined by EAUS has been described to correlate with incontinence symptoms [23,24]. However, it is important to note that a recent large retrospective study showed that severity of anal incontinence was not associated with the extent and location of anal sphincter injury diagnosed on EAUS [25].…”

Section: Discussionsupporting

confidence: 89%

Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)—a nested case-controlled study

Okeahialam

Thakar

Naidu³

et al. 2020

Int Urogynecol J

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Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a significant risk factor for developing anal incontinence. It can therefore be hypothesised that recurrent OASI in a subsequent delivery may predispose women to further anal sphincter dysfunction. Methods A nested case-controlled study based on data collected prospectively between 2006 and 2019. Women matched for age and ethnicity, with a history of one OASI and no sphincter damage in a subsequent delivery (control) were compared to women sustaining a second OASI. Assessment was carried out using the St Mark’s score (SMIS), anorectal manometry and endoanal ultrasound scan (findings quantified using the modified Starck score). Results Eighty-four women were included and equally distributed between the two groups, who were followed up 12 weeks postnatally. No difference in SMIS scores was found. Maximum resting pressure (MRP, mmHg) and maximum squeeze pressure (MSP, mmHg) were significantly reduced in the study group. Median (IQR) MRP in the study group was 40.0 (31.3–54.0) versus 46.0 (39.3–61.5) in the control group (p = 0.030). Median (IQR) MSP was 73.0 (58.3–93.5) in the study group versus 92.5 (70.5–110.8) (p = 0.006) in the control group. A significant difference (p = 0.002) was found in the modified Starck score between the study group (median 0.0 [IQR 0.0–6.0]) and control group (median 0.0 [IQR 0.0–0.0]). Conclusions We have demonstrated that women with recurrent OASI do not have significant anorectal symptoms compared to those with one OASI 12 weeks after delivery, but worse anal sphincter function and integrity. Therefore, on long-term follow-up, symptoms may possibly develop. This information will be useful when counselling women in a subsequent pregnancy.

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Section: Discussionsupporting

confidence: 89%

Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)—a nested case-controlled study

Okeahialam

Thakar

Naidu³

et al. 2020

Int Urogynecol J

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“…The extent of anal sphincter defect as detected by anal ultrasonography has been correlated to the severity of fecal incontinence in other populations. In a study of 250 women with a history of vaginal delivery the authors were unable to find any significant correlation between the size of an anal sphincter defect and severity of fecal incontinence 7 . The extent of the internal anal sphincter was proportionally correlated to a decrease in the mean resting anal pressure.…”

Section: Discussionmentioning

confidence: 91%

Correlation of anorectal manometry measures to severity of fecal incontinence in patients with anorectal malformations – a cross-sectional study

Bjørsum-Meyer

Christensen

Jakobsen

et al. 2020

Sci Rep

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Anorectal malformations (ARM) are a spectrum of anomalies of the rectum and anal canal affecting 1 in 2500 to 5000 live births. Functional problems are common and related to the type of ARM and associated malformations. We aimed to evaluate the results of Three-dimensional High Resolution Anorectal Manometry (3D-HRAM) in long-term follow-up after surgical correction of ARM with special reference to fecal incontinence. twenty-one patients with anorectal malformations and primary repair at our center consented to participate in the study. pressures of the anal sphincter muscles and defects were addressed by 3D-HRAM. Fecal incontinence and disease-specific quality of life were evaluated by the fecal incontinence Quality of Life score and Wexner incontinence score respectively. the study was approved by the Committee in Health Research Ethics and the Danish Data Protection Agency. Median age was 22(12-31) years and 13(67%) participants were females. Sphincter defect was present in 48% (n = 10) of participants. Participants with sphincter defects had significant higher Wexner score and size of sphincter defects and mean anal squeeze pressure were correlated to Wexner score. Participants with or without sphincter defects did not differ on manometry parameters including resting anal and squeeze pressure or disease-specific quality of life. In a study of the long-term outcome after repair of anorectal malformations we found a higher Wexner incontinence score in the presence of an anal sphincter defect and the size of the defect and mean anal squeeze pressure were correlated to the Wexner incontinence score.

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“…Due to the low success of secondary repair in patients with FI, the preference for sacral nerve stimulation instead of surgery has increased in cases where primary repair was inadequate or sphincter defects was not detected in the initial assessment (12,14). Leo et al (34) have reported that 381 patients with AI achieved 60% recovery with sacral nerve stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…Mean resting pressure (RP) and squeeze pressure (SP) of the cases were determined by anal manometry. The presence of AI and FI after more than one year following a primary repair was classified as long-term (14). The patients were divided into three groups according to the time elapsed until anal manometry, and incontinence questionnaires were performed after the operation.…”

Section: Application Of Anal Incontinence Scoring Questionnaire and D...mentioning

confidence: 99%

Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries

et al. 2022

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Objective: The effective way to reduce the risk of fecal incontinence (FI) in primary repaired obstetric anal sphincter injuries (OASIS) patients is to accurately detect the injury and provide complete anatomical reconstruction. The aim of the study was to evaluate the short-term and long-term results of OASIS cases that were diagnosed by an experienced surgical team and whose perineal body and anal sphincters were reconstructed separately. Material and Methods: Sixteen patients that required consultations due to anal sphincter damage during vaginal delivery and underwent anatomical reconstruction due to Grade 3c and Grade 4 sphincter damage between 2007 and 2019 were included in the study. These cases were divided into three groups [Group 1 (≤12 months), Group 2 (12-60 months), Group 3 (≥60 months)] according to the time elapsed until anal manometry, and incontinence questionnaires were conducted in the postoperative period. Recto-anal inhibitory reflex (RAIR), mean resting (IB) and squeezing (SB) pressures were measured by anal manometry. Anal incontinence (AI) and FI rates were determined by questionnaires. Anal sphincter damage repair techniques (overlapping, end-to-end) were determined. These parameters were compared between the three groups. Results: Mean age of the patients was 27.5 (16-35) years. Six (37.5%) patients had Grade 3c, while 10 (62.5%) had Grade 4 injury. The overall mean RP and SP were 35 (26-56) mmHg and 67 (31-100) mmHg, respectively. Mean RP and SP were 46/67 mmHg, 33.5/75.5 mmHg, and 37.5/70.5 mmHg in Groups 1, 2, and 3 respectively. There was no difference between the three groups in terms of mean RP and SP (p= 0.691, p= 0.673). The rate of AI and FI in all patients were 18.75% and 12.5%, respectively while the rate of severe AI incontinence was 6%. Severe AI was observed in 1 (16.7%) case in Group 1, mild AI was observed in 1 (25%) case in group 2, and in 1 (16.7%) case in Group 3. RAIR was positive in all patients. In Group 1, 5 (83.3%) patients underwent overlapping repair, and in Group 3, 6 (100%) patients underwent end-to-end repair. This difference was statistically significant (p= 0.011). Conclusion: In vaginal births, evaluation of anal sphincter damage, determination of perineal body structures and anal sphincters separately and performing anatomical reconstruction when needed significantly reduce the rate of FI in the short and long term.

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Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term?

Cited by 12 publications

References 45 publications

Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)—a nested case-controlled study

Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)—a nested case-controlled study

Correlation of anorectal manometry measures to severity of fecal incontinence in patients with anorectal malformations – a cross-sectional study

Short and long term results of anatomical reconstruction of perineal body and sphincter complex in obstetric anal sphincter injuries

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