Is There Any Correlation Between Objective Anal Testing, Rupture Grade, and Bowel Symptoms After Primary Repair of Obstetric Anal Sphincter Rupture?

Abstract

Anal sphincter rupture and transanal ultrasound grade correlated with each other ( rs= 0.427, P= 0.001). Both rupture and transanal ultrasound grade correlated with soiling grade ( rs= 0.2, P= 0.03 for both), but in a multiple regression analysis, only transanal ultrasound grade was significant ( P= 0.001) as an independent variable. Anal incontinence score correlated with all the manometry variables, but in a multiple regression analysis, only squeeze pressure was significant ( P= 0.001, beta = -0.4) as an independent variable. Both anal sphincter rupture and transanal ultrasound grade were correlated with manometry variables, but only transanal ultrasound grade was significant as an independent variable after multiple regression analysis. The frequency of transanal ultrasound-verified extensive defect of anal sphincter was higher in rupture Grade 3B (25; 95 percent confidence interval, 12-38 percent) and Grade 4 (45; 95 percent confidence interval, 24-66 percent) than in Grade 3A (2.8; 95 percent confidence interval, -1 to -6.6 percent).(s) (s)CONCLUSION Manometry variables are significantly lower in incontinent females than in continent females, and the Wexner incontinence score was correlated with manometry variables. Both anal sphincter rupture and transanal ultrasound grade correlated with soiling grade and with manometry variables, but in both cases only the transanal ultrasound grade was a significant independent variable.

The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence

“…In agreement with other research teams we found a high frequency of endosonographic sphincter defects after primarily sutured sphincter tears 4,8,20,25 . By using an endosonographic defect scoring system we quantified the sphincter damage and described its change over time.…”

“…This might be explained by difficulties with correctly classifying the tear at surgical repair and/or by lack of statistical power, there being only three fourthdegree tears in our study. Nazir and colleagues found endosonographic defects to be significantly larger in a group of women with a total third-degree tear or a fourthdegree tear than in a group with a partial third-degree tear 25 .…”

“…Thus there is reason to believe that the endosonographic sphincter defect score is related to sphincter function -at least to some extent. The relation between endosonographic sphincter defects and sphincter pressure has been studied by others 6,11,25 , but only Nazir and coworkers graded the endosonographic defects 25 . Our results are in agreement with theirs: categorizing endosonographic sphincter defects into three groups according to their extent, Nazir and colleagues found low sphincter pressures only in women with large endosonographic sphincter defects.…”

Predicting anal sphincter defects: the value of clinical examination and manometry

“…It has previously been shown that anal sphincter defects are associated with lower resting and squeeze pressure in women following OASIS [2,[14][15][16]. However, no definitive cut-off values that discriminate between an intact sphincter and the presence of an anal sphincter defect have been published.…”

Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?

“…The reported incidence of anal incontinence after such injury is extremely high [4] and is believed to affect millions of women worldwide [5]. Anal incontinence incorporates a range of symptoms, including flatus incontinence, passive soiling, and incontinence of solid or liquid stool, which is a social and hygienic problem [6].…”