Long‐term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints

Abstract

Objective To determine the long-term effects of obstetric anal sphincter rupture on the frequency of faecal incontinence and sexual complaints.Design Retrospective case-control study.Setting Department of Gynaecology and Obstetrics, Ikazia Hospital, The Netherlands.Population All 171 women operated for anal sphincter rupture between 1971 and 1990 and 171 controls matched for parity and date of delivery.Methods Postal questionnaires regarding faecal incontinence were sent in 1996 and 2005 to all cases and controls with questions regarding sexual complaints added to the questionnaire in 2005.Main outcome measures Anorectal complaints defined as any form of faecal incontinence including faecal urgency and faecal soiling. Sexual complaints defined as dyspareunia or faecal incontinence during intercourse.Results Sixty-one percent of the women responded to both questionnaires. Anorectal complaints were reported by 38% of case versus 16% of controls in 1996 (risk difference: 0.22, 95% CI 0.10-0.34) and by 61% of cases versus 22% of controls in 2005 (risk difference: 0.41, 95% CI 0.29-0.53). In contrast to the control group, the increase of anorectal complaints in the case group between 1996 and 2005 was highly significant (P < 0.0001). Postmenopausal state was not associated with an increased risk for faecal incontinence. Dyspareunia was reported by 29% of cases versus 13% of controls (P = 0.01). Faecal incontinence during intercourse was reported by 13% of cases versus 1% of controls (P = 0.005).Conclusions Obstetric anal sphincter rupture is an important risk factor for sexual complaints and for faecal incontinence increasing with age irrespective of menopausal state.Keywords Incontinence, sexual complaints, sphincter rupture.Please cite this paper as: Mous M, Muller S, de Leeuw J. Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints. BJOG 2008;115:234-238.

Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery

“…The results of this study suggested that women with anal sphincter disruption had a slightly increased risk of fecal incontinence with no impact on urinary or sexual symptoms and mental or physical health [11]. In contrast, other authors reported a higher incidence of urinary symptoms [12,13] and sexual dysfunction [5,7,14,15] after anal sphincter tear.…”

“…To estimate a sample size, we used five studies that evaluated fecal incontinence after an anal sphincter tear [5,6,9,13,14]. Based on these studies, the overall fecal incontinence rate was 40% (21-57%) and 20% (7-32%) for women with and without an anal sphincter tear, respectively.…”

“…Similar sample size was calculated based on the literature that evaluated sexual dysfunction [5,14]. The literature was insufficient to determine the sample size necessary for urinary incontinence.…”

“…Tears in the connective and muscular tissue as well as compression of the vascular supply and nerve bundles represent direct and indirect trauma responsible for defects in pelvic organ support and functional alterations of surrounding organs. A thirddegree tear increases the risk of fecal incontinence [4][5][6], although long-term results are conflicting [7,8]. Nygard et al found a large number of fecal incontinence in middleaged women, without statistical differences between the episiotomy, anal sphincter tear, or Caesarean groups [8].…”

Feeling old in a young body: Women’s experiences of living with severe consequences of an obstetric anal sphincter rupture: An interview study

“…Anxiety about resumption of an active sex life after OASR and its deleterious effect on sexual function have been described in earlier studies. [23][24][25][26] Participants told of shame and guilt due to the reduction in sex life and its effects on their partner. Bearing in mind the anxiety and iso-lation which the women felt, it seems highly likely that partners also feel similar emotions, and therefore have the same needs for discussion, support, and information.…”