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

Starck, M.; Bohe, Måns; Valentin, Lil

doi:10.1002/uog.2630

Cited by 92 publications

(59 citation statements)

References 29 publications

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“…This finding is similar to two other recent studies. Stark et al found an association between an increasing anal endosonographic defect score (range, 0-16) and the Wexner Anal Incontinence Questionnaire, after repair of an obstetric anal sphincter laceration [17]. Mahoney et al found that endosonographic IAS defects, but not EAS defects, were predictive of anal incontinence after repair of obstetric anal sphincter lacerations [18].…”

Section: Discussionmentioning

confidence: 99%

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Vaccaro

Clemons

2008

Int Urogynecol J

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A study was carried out to identify (1) incidence of anal incontinence symptoms, (2) incidence and size of both external anal sphincter (EAS) and internal anal sphincter (IAS) defects, and (3) relationship between anal incontinence symptoms and IAS or EAS defect size after repair of an obstetric anal sphincter laceration. Forty-seven vaginally primiparous women underwent obstetric anal sphincter laceration repair. At 8-12 weeks postpartum, anal incontinence symptoms were assessed, and endoanal ultrasound was performed. At 1-2 years postpartum, symptoms were reassesseds. The incidence of anal incontinence symptoms at 8-12 weeks was 43%. The incidence of IAS and EAS defects were 32% and 77%, respectively. IAS defects > or = 45 degrees were predictive of symptoms (p = 0.02). After 18 months mean follow-up, 11% reported chronic symptoms. After anal sphincter laceration repair, anal incontinence symptoms occur in 43% of women and remain chronic in 11%. Anal incontinence symptoms are associated with increasing IAS defect size.

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Section: Discussionmentioning

confidence: 99%

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Vaccaro

Clemons

2008

Int Urogynecol J

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“…Obstetric sphincter defects repaired primarily at the time of delivery may increase in size with time, and the size of the defect corresponds to an increased risk of fecal incontinence [ 29 ]. Several studies have demonstrated that patients with persisting sphincter defects after overlapping sphincteroplasty have impaired outcomes [ 20 , 30 ].…”

Section: Anatomic Evaluation Ultrasound 2dmentioning

confidence: 99%

Common Tests for the Pelvic Floor

Sands

Thorsen

2016

The ASCRS Textbook of Colon and Rectal Surgery

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“…5a et 5b). Or, la persistance d'une rupture échographique est fortement liée au risque d'incontinence anale à long terme après l'accouchement [23,24]. De plus, nous avons observé [2] que les déchirures du périnée cotées stades 1 ou 2 par l'obstétricien (respectant donc en théorie le sphincter) étaient souvent associées à une rupture sphinctérienne ignorée (stade 1 : neuf ruptures sphinctériennes sur 48 parturientes et stade 2 : quatre ruptures sphinctériennes sur quatre parturientes).…”

Section: Facteurs De Risque De Lésion Du Nerf Honteux Interneunclassified

Incontinence anale du post-partum

Abramowitz

2009

Pelv Perineol

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L'incontinence anale est un symptôme tabou qui le restera si on n'aborde pas franchement le sujet avec nos patientes. L'accouchement par voie basse peut occasionner une incontinence anale dans 10 à 15 % des cas. Elle porte le plus souvent sur les gaz et s'améliore avec le temps ou la rééducation. Cependant, ces accouchements difficiles sont l'une des principales causes d'affaiblissement du périnée elles-mêmes responsables de l'incontinence anale des femmes d'âge mûr. L'incontinence anale du post-partum est secondaire à une rupture des sphincters externe et/ou interne de l'anus ou à une lésion du nerf honteux interne (qui commande le sphincter externe). Les principaux facteurs de risque sont la déchirure du périnée, les forceps, le premier et le second accouchement et une épisiotomie trop médiane. Lorsque l'incontinence anale persiste au-delà de six mois, il est nécessaire de l'explorer (manométrie anorectale et échographie endoanale) en vue d'une prise en charge thérapeutique (rééducation anale et parfois sphinctérorraphie, voire neuromodulation sacrée). Enfin, il est parfois légitime de discuter l'indication d'un accouchement par césarienne en vue de préserver l'anus. Mots clés Incontinence anale · Accouchement · Post-partum · PréventionAbstract Anal incontinence is a taboo symptom that needs specific screening. It is observed in 10 to 15% of patients after delivery, essentially with respect to gas incontinence. It frequently disappears with time or after re-education. But repeated traumatic deliveries are responsible for long-term anal incontinence. Anal sphincter rupture and pudendal lesions are the causes of post-partum anal incontinence. The more significant factors are perineal tears, forceps, the first and second delivery and midline episiotomy. If anal incontinence persists six months after delivery, anal manometry and anal endosonography are useful to determine therapeutic management. Finally, caesarean section is sometimes indicated to protect anal function.

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

Abstract: ABSTRACT

Cited by 92 publications

References 29 publications

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women

Common Tests for the Pelvic Floor

Incontinence anale du post-partum

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