Postpartum anal incontinence in women with and without obstetric anal sphincter injuries

Everist, Rebecca; Burrell, Madeline; Mallitt, Kylie‐Ann; Parkin, Katrina; Patton, Vicki; Karantanis, Emmanuel

doi:10.1007/s00192-020-04267-8

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…This is in accordance with the literature that reports that severe fecal incontinence increases three‐fold and five‐fold after one or two OASIS compared with childbirth where OASIS did not occur 4 . Notably, some authors report that grades 3a and 3b OASIS do not lead to a higher risk for anal incontinence than no OASIS while grade 3c and 4 do 13,18 . Unfortunately, the database did not allow us to differentiate the between types of grade 3 OASIS.…”

Section: Discussionsupporting

confidence: 88%

“…Women should be warned of the risk of anal incontinence, especially given the high level of OASIS. 13 The Canadian guidelines recommend that providers disclose to women the degree of injury that they suffered, and refer patients with anal incontinence for pelvic floor physiotherapy. 14 Despite this, there is no mention that those who are at high risk, or those who are experiencing anal incontinence be referred to an anal incontinence specialist.…”

Section: Discussionmentioning

confidence: 99%

“…4 Notably, some authors report that grades 3a and 3b OASIS do not lead to a higher risk for anal incontinence than no OASIS while grade 3c and 4 do. 13,18 Unfortunately, the database did not allow us to differentiate the between types of grade 3 OASIS. This is because the recommendation to subdivide grade 3 OASIS in France was only published in 2018, 6 whereas the data from the cohort used in this study were collected for the year 2012.…”

Section: Discussionmentioning

confidence: 99%

“…This demonstrates that this pathology is under‐diagnosed and under‐managed in young women, which is perhaps due to poor information provided after childbirth. Women should be warned of the risk of anal incontinence, especially given the high level of OASIS 13 . The Canadian guidelines recommend that providers disclose to women the degree of injury that they suffered, and refer patients with anal incontinence for pelvic floor physiotherapy 14 .…”

Section: Discussionmentioning

confidence: 99%

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Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis

Levaillant

Legendre

Rebmann

et al. 2022

Intl J Gynecology & Obste

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Objective To assess the relationship between anal incontinence (AI) 8 years after childbirth and the occurrence of obstetrical anal sphincter injuries (OASIS) and/or performance of an episiotomy during childbirth. Methods This is a nationwide database analysis performed on two national medico‐administrative databases, including all the women aged 18 years or older who delivered infants in France in 2012. The main outcome measure was AI in the 8 years after delivery. Results Of the 163 443 perineal tears reported, 0.47% were grade 3 (n = 3173) and 0.08% were grade 4 (n = 579); 8938 women experienced AI (1.33%) and 261 women experienced severe AI (0.04%). Episiotomies performed in the absence of risk factors for OASIS were significantly associated with an increased risk of AI (odds ratio [OR] 1.59, 95% confidence interval [CI]1.49–1.69; P < 0.001). Grade 3 and 4 OASIS also significantly increased the risk of AI and severe AI. Mediolateral episiotomy was preventive of OASIS when performed in women at risk (OR 0.26, 95% CI 0.23–0.30; P < 0.001) but contributed to OASIS in the absence of risk (OR 2.18, 95% CI 1.98–2.40; P < 0.001). Conclusion OASIS present a risk factor for AI. Episiotomies could reduce the occurrence of OASIS, but they could also increase the risk of long‐term AI in the absence of risk factors for OASIS.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis

Levaillant

Legendre

Rebmann

et al. 2022

Intl J Gynecology & Obste

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show abstract

“…Interestingly, there are only two prospective studies reporting AI rates for women with 3a, 3b, and 3c tears. 12,22 The majority of the studies including the Sultan classification were retrospective. 10,13,26,29,31 Shortterm data are mainly available, with follow-up ranging between 1 and 12 months.…”

Section: Discussionmentioning

confidence: 99%

Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review

Zacchè

Ghosh

Liapis

et al. 2023

Neurourology and Urodynamics

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AimsObstetric anal sphincter injury (OASI) is associated with long‐term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth‐degree tear more likely to cause AI over a third‐degree tear?MethodsA systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross‐sectional and case‐control studies without language restrictions. The quality was assessed by the Newcastle‐Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI.ResultsOut of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross‐sectional studies. Length of follow‐up ranged from 1 month to 23 years, with the majority of the reports (n = 16) analysing data within 12‐months postpartum. Third‐degree tears evaluated were 6454 versus 764 fourth‐degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two‐ to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth‐degree tears, but this failed to reach statistical significance. Cross‐sectional studies with long‐term (≥5 years) follow‐up showed that women with fourth‐degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow‐up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth‐degree tear and FI.ConclusionsMost studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long‐term follow‐up should be performed to evaluate the risk of AI for each OASI subtype.

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The incidence of anal incontinence following obstetric anal sphincter injury graded using the Sultan classification: a network meta-analysis

Okeahialam¹,

Taithongchai²,

Thakar³

et al. 2023

American Journal of Obstetrics and Gynecology

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Postpartum anal incontinence in women with and without obstetric anal sphincter injuries

Cited by 10 publications

References 27 publications

Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis

Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis

Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review

The incidence of anal incontinence following obstetric anal sphincter injury graded using the Sultan classification: a network meta-analysis

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