Aims
To evaluate the benefit of performing anorectal studies on all women following primary obstetric anal sphincter injury (OASI) repair over performing them on symptomatic women only.
Methods
Women who attended perineal clinic between 2007 and 2020 underwent symptom assessment and anorectal studies at 6 weeks and 6 months postpartum. Anorectal studies including endo anal ultrasound (EAUS) and anal manometry (AM) were performed. The anorectal studies of symptomatic women who were the case group, were compared with asymptomatic women who were the control group.
Results
A total of 1348 women were seen in the perineal clinic over 13 years. A total of 454 (33.7%) women were symptomatic. A total of 894 (66.3%) women were asymptomatic. A total of 313 (35%) asymptomatic women had two abnormal anorectal studies, 274 (31%) had abnormal AM alone, and 86 (9.6%) had abnormal EAUS alone. A total of 221 (24.7%) asymptomatic women had normal anorectal studies.
Conclusion
Almost 70% of women were asymptomatic 6 months following primary OASI repair. Most had at least one abnormal anorectal study result. Selectively performing anorectal tests on symptomatic women would not identify asymptomatic women at risk of future faecal incontinence following further vaginal birth. Without anorectal study results, women would not receive accurate counseling about the risks of vaginal birth. Anorectal studies should be offered to all women following OASI where resources allow.
Objective To evaluate the benefit of performing anorectal studies on all
women following primary Obstetric Anal Sphincter Injury (OASI) repair
over performing them on symptomatic women only. Design Retrospective
observational study. Setting Tertiary maternity unit in the U.K.
Population or sample All women followed up in the perineal clinic over
13 years were included. Methods Women who attended perineal clinic
between 2007 and 2020 underwent symptom assessment and anorectal studies
at 6 weeks and 6 months post-partum. Anorectal studies including endo
anal ultrasound (EAUS) and anal manometry (AM) were performed. The
anorectal studies of symptomatic women who were the case group, were
compared with asymptomatic women who were the control group. Main
outcome Results 1,348 women were seen in the perineal clinic over 13
years. 454 (33.7%) women were symptomatic. 894 (66.3%) women were
asymptomatic. 313 (35%) asymptomatic women had two abnormal anorectal
studies, 274 (31%) had abnormal AM alone and 86 (9.6%) had abnormal
EAUS alone. 221 (24.7%) asymptomatic women had normal anorectal
studies. Conclusion Almost 70% of women were asymptomatic 6 months
following primary OASI repair. Most had at least one abnormal anorectal
study result. Selectively performing anorectal tests on symptomatic
women would not identify asymptomatic women at risk of future faecal
incontinence (FI) following further vaginal birth. Without anorectal
study results, women would not receive accurate counselling about the
risks of vaginal birth. Anorectal studies should be offered to all women
following OASI where resources allow.
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