Womenʼs experience of anal incontinence following a history of obstetric anal sphincter injury: a literature review

Abstract

Background Anal incontinence (AI) is the involuntary loss of a liquid or solid stool and flatus, resulting in a lifelong profound negative impact on a person's quality of life. One million Australians, half of whom are women, are affected by AI. The aetiology of AI is reported within research literature. Importantly obstetric anal sphincter injury following vaginal delivery is a predominant cause of AI. Factors cited as major risk factors of anal sphincter damage include instrumental delivery, macrosomia and primiparity. The incidence of AI increases with age and with further vaginal delivery. The impact lasts for life. Aim This study aims to identify women's experiences of AI following obstetric anal sphincter injury and their impact on quality of life. Method An extensive online literature search was undertaken within the medical and nursing databases including the Cumulative Index of Nursing and Allied Health Literature, Scopus, PubMed and Medline. Key search terms included AI, faecal incontinence, anal sphincter injuries, obstetric complications, trauma, obstetric, postnatal care, experiences, women's experience and quality of life. The literature search was further refined through fields that included English language only, literature published between 2000 and 2012 and full‐text articles. Findings The review identified a significant amount of research literature that addressed the prevalence and cause of AI. While quality of life questionaries and symptom severity scores have been utilised to assess the impact of AI on a person's life, there are inherent weaknesses in providing the experience of AI on a person's life. Furthermore, there is limited in‐depth research that addresses women's experiences of AI following a history of obstetric anal sphincter injury and the impact on their quality of life. Conclusion Research findings contribute to understanding the prevalence, physical, social and emotional impact of AI. While alterations in clinical practice can improve the identification and management of AI, further research that builds on the state of knowledge and seeks a deeper understanding of the issues for women with AI as a result of obstetric anal sphincter injury is required.

Teetering near the edge; women's experiences of anal incontinence following obstetric anal sphincter injury: an interpretive phenomenological research study

“…Results indicate there are long‐term implications for sufferer's identity in many of the complex roles they play socially and professionally throughout their lives. QoL questionnaires have identified the negative impact of AI on quality of life; however, they provided limited in‐depth insight into women's experiences . The reported research is therefore warranted and appropriate in exploring women's experiences of AI.…”

“…The detrimental impact of AI on lifestyle, social functioning, financial burden, enforced social isolation, coping difficulties, depression, negative self‐image, fear, embarrassment, anxiety due to unpredictability and sexual matters is reported utilising clinically derived quality of life questionnaires (QoL) . QoL questionnaires provide valuable insight; however, these questionnaires are limited in that they are typically clinically derived, disease specific and often objectively skim the surface as to the profound impact of AI on a person's life …”

“…Health professional's negative attitudes reinforce stigma and isolation and impacts on a deeper understanding of AI being espoused . Research which provides any in‐depth analysis of women's experiences of AI following a history of OASIS is limited . Interpretive phenomenology, a qualitative research methodology, provides a deeper understanding and interpretation of an experience in the context of a person's life .…”

Prevalence of high-grade perineal tear during labor in Mexican adolescents

“…It is estimated that third- and fourth-degree tears occur in 0.8% of all vaginal deliveries in Mexico 15 . Likewise, obstetric anal sphincter injuries are associated with short and long-term sequelae, mainly anal incontinence, rectovaginal fistulas, wound dehiscence, and abscess formation, which affect physically and psychologically patients 11 , 16 - 18 . In addition, fistulas and fecal incontinence 19 , 20 are mostly due to inadequate reconstruction of the anal sphincter, which is associated with medico-legal problems and increased health care costs 21 .…”

“…Se estima que en la población general, los desgarros de tercer y cuarto grado ocurren en el 0.8% de todos los partos vaginales en México 15 . Así mismo se asocian las lesiones obstétricas del esfínter anal, con secuelas a corto y largo plazo, principalmente incontinencia anal, fístulas rectovaginales, dehiscencia de heridas y formación de abscesos, que afectan a las pacientes física y psicológicamente 11 , 16 - 18 . Además, las fístulas y la incontinencia fecal 19 , 20 , son en su mayoría, consecuencia de una inadecuada reconstrucción del esfínter, lo que se asocia a problemas médico-legales y elevación de costos en atención en salud 21 .…”