Advertisement

Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth

      Objective

      The purpose of this study was to investigate the long-term impact of anal sphincter laceration on anal incontinence.

      Study Design

      Five to 10 years after first delivery, anal incontinence and other bowel symptoms were measured with the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetric exposures were assessed with review of hospital records. Symptoms and quality-of-life impact were compared among 90 women with at least 1 anal sphincter laceration, 320 women who delivered vaginally without sphincter laceration, and 527 women who delivered by cesarean delivery.

      Results

      Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio, 2.32; 95% confidence interval, 1.27–4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality-of-life scores were similar between women who delivered by cesarean section and those who delivered vaginally without sphincter laceration.

      Conclusion

      Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Macmillan A.K.
        • Merrie A.E.
        • Marshall R.J.
        • Parry B.R.
        The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature.
        Dis Colon Rectum. 2004; 47: 1341-1349
        • Bols E.M.
        • Hendriks E.J.
        • Berghmans B.C.
        • Baeten C.G.
        • Nijhuis J.G.
        • de Bie R.A.
        A systematic review of etiological factors for postpartum fecal incontinence.
        Acta Obstet Gynecol Scand. 2010; 89: 302-314
        • Borello-France D.
        • Burgio K.L.
        • Richter H.E.
        • et al.
        Fecal and urinary incontinence in primiparous women.
        Obstet Gynecol. 2006; 108: 863-872
        • Fenner D.E.
        • Genberg B.
        • Brahma P.
        • Marek L.
        • DeLancey J.O.
        Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States.
        Am J Obstet Gynecol. 2003; 189: 1543-1550
        • Kammerer-Doak D.N.
        • Wesol A.B.
        • Rogers R.G.
        • Dominguez C.E.
        • Dorin M.H.
        A prospective cohort study of women after primary repair of obstetric anal sphincter laceration.
        Am J Obstet Gynecol. 1999; 181: 1317-1323
        • van Brummen H.J.
        • Bruinse H.W.
        • van de Pol G.
        • Heintz A.P.
        • van der Vaart C.H.
        Defecatory symptoms during and after the first pregnancy: prevalences and associated factors.
        Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17: 224-230
        • Baud D.
        • Meyer S.
        • Vial Y.
        • Hohlfeld P.
        • Achtari C.
        Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery.
        Int Urogynecol J. 2011; 22: 1127-1134
        • Faltin D.L.
        • Otero M.
        • Petignat P.
        • et al.
        Women's health 18 years after rupture of the anal sphincter during childbirth: I, fecal incontinence.
        Am J Obstet Gynecol. 2006; 194: 1255-1259
        • Nordenstam J.
        • Altman D.
        • Brismar S.
        • Zetterstrom J.
        Natural progression of anal incontinence after childbirth.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 1029-1035
        • Handa V.L.
        • Blomquist J.L.
        • Knoepp L.R.
        • Hoskey K.A.
        • McDermott K.C.
        • Munoz A.
        Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth.
        Obstet Gynecol. 2011; 118: 777-784
        • Hale R.
        • Ling F.
        Episiotomy: procedure and repair techniques; the American Congress of Obstetricians and Gynecologists Web site.
        (Accessed: Oct. 21, 2011)
        • Lukacz E.S.
        • Lawrence J.M.
        • Buckwalter J.G.
        • Burchette R.J.
        • Nager C.W.
        • Luber K.M.
        Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey.
        Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 272-284
        • Barber M.D.
        • Walters M.D.
        • Bump R.C.
        Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7).
        Am J Obstet Gynecol. 2005; 193: 103-113
        • Handa V.L.
        • Blomquist J.L.
        • McDermott K.C.
        • Friedman S.
        • Munoz A.
        Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth.
        Obstet Gynecol. 2012; 119: 233-239
        • Rice F.
        • Lewis A.
        • Harold G.
        • et al.
        Agreement between maternal report and antenatal records for a range of pre and peri-natal factors: the influence of maternal and child characteristics.
        Early Hum Dev. 2007; 83: 497-504
        • Elkadry E.
        • Kenton K.
        • White P.
        • Creech S.
        • Brubaker L.
        Do mothers remember key events during labor?.
        Am J Obstet Gynecol. 2003; 189: 195-200
        • Melville J.L.
        • Fan M.Y.
        • Newton K.
        • Fenner D.
        Fecal incontinence in US women: a population-based study.
        Am J Obstet Gynecol. 2005; 193: 2071-2076
        • Johanson J.F.
        • Lafferty J.
        Epidemiology of fecal incontinence: the silent affliction.
        Am J Gastroenterol. 1996; 91: 33-36
        • Bagade P.
        • Mackenzie S.
        Outcomes from medium term follow-up of patients with third and fourth degree perineal tears.
        J Obstet Gynaecol. 2010; 30: 609-612