Impact of residual defect of anal sphincter on patient’s quality of life

2021 ◽  
Vol 86 (3) ◽  
pp. 163-166
Author(s):  
Petr Hubka ◽  
◽  
Rachid El Haddad ◽  
Jaromír Mašata ◽  
Alois Martan ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Sphincter Injury ◽  
Sphincter Defect ◽  
Anal Sphincter Injury ◽  
Sphincter Defects ◽  
Anal Sphincter Defect ◽  
Anal Sphincter Defects ◽  
Obstetrical Anal Sphincter Injury ◽  
Fecal Urgency

Summary Aim: The aim of this retrospective study is to correlate the presence of residual anal sphincter defect with the quality of life of patients after vaginal delivery complicated with obstetrical anal sphincter injury. Study group and methods: Patients diagnosed with obstetrical anal sphincter injury are dispensed at our urogynecological unit, with a mean follow-up period of 37 months. Two investigators blinded to the results of clinical symptoms evaluated archived ultrasound volumes taken for the presence of residual anal sphincter defects that were later correlated with the St. Mark’s Incontinence Score. Results: The group comprises of 181 patients diagnosed with an obstetrical anal sphincter injury who underwent ultrasound examination of anal sphincter at three post-partum months. The questionnaires were completed by 118 patients (65.2% of all patients). A residual sphincter defect was diagnosed in seven cases (5.9%). In the group with residual defects, fecal urgency (lack of ability to defer defecation) was present in 57.1%. In the group without residual anal sphincter defects, fecal urgency was present in 12.6%. This difference is significant (< 0.001) with the contingency coefficient 0.291. Conclusions: In conclusion, the presence of residual anal sphincter defect increases the probability of fecal urgency.

scholarly journals Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI)

2020 ◽  
Author(s):  
Nicola Adanna Okeahialam ◽  
Ranee Thakar ◽  
Abdul H. Sultan
Keyword(s):  
Anal Sphincter ◽  
Anal Manometry ◽  
Subsequent Pregnancy ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Sphincter Defect ◽  
Squeeze Pressure ◽  
Anal Sphincter Injury ◽  
Significant Difference ◽  
Anal Sphincter Defect

Abstract Introduction and hypothesis Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 and p = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum. Conclusions Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.

Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injury

2007 ◽  
Vol 196 (3) ◽  
pp. 217.e1-217.e5 ◽  
Author(s):  
Rhona Mahony ◽  
Michael Behan ◽  
Leslie Daly ◽  
Catriona Kirwan ◽  
Colm O’Herlihy ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Sphincter Defect ◽  
Anal Sphincter Injury ◽  
Anal Sphincter Defect

scholarly journals Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome?

2018 ◽  
Vol 100 (1) ◽  
pp. 26-32 ◽  
Author(s):  
L Ramage ◽  
C Yen ◽  
S Qiu ◽  
C Simillis ◽  
C Kontovounisios ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Short Form ◽  
Primary Repair ◽  
Obstetric Anal Sphincter Injury ◽  
Short Term ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.

Impact of mediolateral episiotomy on incidence of obstetrical anal sphincter injury diagnosed by endoanal ultrasound

Midwifery ◽  
2017 ◽  
Vol 51 ◽  
pp. 40-43 ◽  
Author(s):  
Kristina Drusany Staric ◽  
Adolf Lukanovic ◽  
Petra Petrocnik ◽  
Vita Zacesta ◽  
Corrado Cescon ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Endoanal Ultrasound ◽  
Sphincter Injury ◽  
Mediolateral Episiotomy ◽  
Anal Sphincter Injury ◽  
Obstetrical Anal Sphincter Injury

Risk and Outcome of Obstetrical Anal Sphincter Injury

2007 ◽  
Vol 13 (4) ◽  
pp. 171-176 ◽  
Author(s):  
James W. Groves ◽  
Raymond T. Foster ◽  
Thomas J. Kuehl ◽  
Paul M. Yandell
Keyword(s):  
Anal Sphincter ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Obstetrical Anal Sphincter Injury

The prevalence of anal incontinence in post-partum women following obstetrical anal sphincter injury

2010 ◽  
Vol 21 (8) ◽  
pp. 927-932 ◽  
Author(s):  
Rainbow Y. T. Tin ◽  
Jane Schulz ◽  
Beth Gunn ◽  
Cathy Flood ◽  
Rhonda J. Rosychuk
Keyword(s):  
Anal Sphincter ◽  
Anal Incontinence ◽  
Post Partum ◽  
Sphincter Injury ◽  
Anal Sphincter Injury ◽  
Obstetrical Anal Sphincter Injury

scholarly journals IIIB-IV Degree Perineal Rupture Repair Using Overlapping and End-to-End Techniques with Pudendal Block Anesthesia

2016 ◽  
Author(s):  
Nuring Pangastuti ◽  
Junizaf Junizaf ◽  
Ibnu Pranoto ◽  
Budi I Santoso ◽  
Tyas Priyatini
Keyword(s):  
Fecal Incontinence ◽  
General Hospital ◽  
Anal Sphincter ◽  
Anal Incontinence ◽  
Control Group ◽  
Sphincter Defects ◽  
Anal Sphincter Defects ◽  
End To End ◽  
Successful Repair ◽  
Fecal Urgency

Objective: To compare the incidence of persistent sonographic anal sphincter defect, fecal urgency, anal and fecal incontinence after IIIb- IV degree perineal rupture repair using overlapping and end-to-end technique. Method: An open clinical trial with randomization was carried out in July 2010-April 2012. The population consisted of the patients who underwent vaginal delivery in Dr. Sardjito Central General Hospital, Sleman District General Hospital, as well as Tegalrejo, Jetis and Mergangsan Community Health Centers who did no have complaints of fecal urgency, anal incontinence, and/or fecal incontinence, and suffered IIIb-IV degree perineal rupture repaired within less than 24 hours of rupture. The exclusion criteria included conditions in which patients could not undergo repair at the moment (shock, uncooperative patient). Fourty-eight research samples were divided into 2 groups, 24 samples for each of the treatment group (overlapping repair) and the control group (end-to-end repair). Local anesthesia was performed in a pudendal-block manner. Result: Success of the repair was assessed based on the presence of persistent sonographic anal sphincter defects in the 6-week evaluation after repair. Successful repair was higher in the overlapping group than that of the end-to-end group (94.74% vs 81.25%, p=0.31). Clinically and based on the Fecal Continence Scoring Scale (FCSS), evaluation at weeks II and VI indicated successful repair in both groups. Conclusion: There was no difference in the incidence of persistent sonographic anal sphincter defects, fecal urgency, anal incontinence, and fecal incontinence, after IIIb-IV degree perineal rupture repair using overlapping technique in comparison with end-to-end technique. Keywords: end-to-end technique, III-IV degree perineal rupture, obstetric perineal rupture, overlapping technique

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