Anal sphincter defects and fecal incontinence 15–24 years after first delivery: a cross‐sectional study

Rojas, R.A. Guzman; Salvesen, Kjell Å.; Volløyhaug, Ingrid

doi:10.1002/uog.18827

Cited by 39 publications

(44 citation statements)

References 36 publications

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“…One limitation was that the population consisted of a large proportion of women with operative vaginal deliveries, due to the design of the parent study. Instrumental delivery has been associated with an increased risk for anal sphincter defects and LAM injury as shown in earlier studies . Since operative vaginal deliveries are associated with PFDs this study population could be more symptomatic than the normal population they were recruited from.…”

Section: Discussionmentioning

confidence: 95%

“…LAM injuries usually occur during the first delivery, whereas UI and FI are diagnosed years later. One strength of this study is a long time interval between the first delivery and assessment of symptoms . Another strength is that women were recruited from the normal population, ensuring that the results are relevant for parous women in general, and not only for patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…Flowchart of the study population. a Three‐hundred sixty nine women were excluded based on the protocol of parent study (due to operative vaginal delivery after a cesarean or normal vaginal delivery or lived too far from Trondheim in 2013 or unable to meet for the exam during inclusion period)…”

Section: Methodsmentioning

confidence: 99%

“…Injury was diagnosed as unilateral or bilateral, and the number of women with significant levator injury (unilateral or bilateral) was registered. A defect of the external or internal anal sphincter of ≥30° in at least four of six slices on tomographic ultrasound imaging was considered a significant defect . BND was assessed in the midsagittal view, see Figure .…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, we calculated the aOR for UUI and SUI for women with and without significant BND and urethral funneling with multiple logistic regression, adjusting for age, BMI, parity, and infant birth weight. Possible confounders were selected based on results from previous studies and clinical experience …”

Section: Methodsmentioning

confidence: 99%

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Levator ani muscle injury and risk for urinary and fecal incontinence in parous women from a normal population, a cross‐sectional study

Mathew

Rojas

Salvesen

et al. 2019

Neurourology and Urodynamics

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Aims To study possible associations between levator ani muscle (LAM) injury and urinary incontinence (UI) and fecal incontinence (FI) and possible associations between bladder neck descent (BND), urethral funneling, and UI. Methods A cross‐sectional study of 608 women with first delivery in 1990 to 1997 assessed in 2013 to 2014. The Urinary Distress Inventory (UDI‐6) and Colorectal Anal Distress Inventory (CRADI‐8) were used to quantify symptoms (range, 0‐100). The proportion of women with UI and FI was calculated. LAM injury, BND ≥25 mm, and funneling were diagnosed with transperineal ultrasound. Women with LAM injury, BND, and urethral funneling were compared to those without, using the Mann‐Whitney U test (symptom scores) and multiple logistic regression analysis (UI and FI). Results Four‐hundred ninety‐three (81%) women had intact LAM and 113 (19%) had LAM injury. They had similar median (range) UDI‐6 score 8.3 (0‐75) vs 4.2 (0‐62.5), P = .35, and CRADI‐8 score 6.3 (0‐78.1) vs 6.3 (0‐62.5), P = .90. Three hundred eleven out of six hundred (52%) women had UI and 65 of 594 (11%) had FI. This was similar for women with intact vs injured LAM; UI 53% vs 49%, P = .67; FI 11% vs 12%, P = .44 and with and without BND; stress UI 42% vs 42%, P = .93; urge UI 29% vs 35%, P = .34. Stress UI was more common in women with urethral funneling (50% vs 40%), odds ratio 1.56 (95% confidence interval: 1.03‐2.37), P = .04. Conclusion We found no associations between LAM injury and symptoms of UI and FI 15 to 24 years after the first delivery, but urethral funneling was associated with stress UI.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Levator ani muscle injury and risk for urinary and fecal incontinence in parous women from a normal population, a cross‐sectional study

Mathew

Rojas

Salvesen

et al. 2019

Neurourology and Urodynamics

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Anal Sphincter Length as Determined by 3‐Dimensional Endoanal Ultrasound and Anal Manometry

Norderval

Pedersen

Collinson

2020

J of Ultrasound Medicine

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Objectives The normal female external anal sphincter (EAS) is shorter anteriorly than laterally and posteriorly. Furthermore, the thickness of the very proximal part of the circular EAS is thinner than 50% of the lateral and posterior EAS thickness. The extent of these features is not fully explored. The aim of this prospective study was to assess the normal anal sphincter with 3‐dimensional (3D) endoanal ultrasound (EAUS) and to relate 3D EAUS length measurements to sphincter length determined by anal manometry. Methods Healthy premenopausal nulliparous women underwent anal manometry and 3D EAUS examinations. Two experienced colorectal surgeons independently assessed all scans, blinded to any patient data. Results A total of 43 women were included. Four scans were incomplete and excluded from the analysis. Interobserver agreement was fair to very good for the various length measurements. The mean length from the distal border of the puborectal muscle to the very proximal border of the anterior EAS (the anterior gap) was 4.4 (95% confidence interval, 3.9–4.9) mm, whereas the length to the level where the anterior EAS thickness was at least 50% of the lateral and posterior EAS thickness was 7.2 (95% confidence interval, 6.5–7.9) mm. Manometric sphincter length at rest did not correlate with any 3D EAUS length measurements. Conclusions In the normal anterior female anal canal, the EAS is not present or appears with less than 50% of the thickness of the lateral and posterior EAS for the first 7.2 mm below the distal border of the puborectal muscle.

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Prevalence of anal sphincter defects and association with anal incontinence in women scheduled for pelvic organ prolapse surgery

Mathew

Rojas

Nyhus

et al. 2020

Neurourology and Urodynamics

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Aims: Some women with pelvic organ prolapse (POP) have concomitant symptoms of anal incontinence. Our aim was to assess the prevalence of anal sphincter defects and the association with incontinence in women undergoing POP surgery. Methods: Cross-sectional study of 200 women scheduled for POP surgery. They answered yes/no and graded any symptoms of fecal and flatal incontinence on a visual analog scale (0-100). 3D/4D transperineal ultrasound was used to assess internal (IAS) and external anal sphincter (EAS) defects. A defect of ≥30°in ≥4 of 6 slices on tomographic imaging was regarded significant. The association between incontinence and sphincter defects was tested with multivariable logistic regression analysis. Results: The prevalence of any sphincter defect was 50/200 (25%). Combined IAS/EAS defect was found in 19/200 (9.5%) women, 8/200 (4.0%) had isolated IAS, and 23/200 (11.5%) had isolated EAS defects. In women with defect and intact IAS, 37% and 11% reported fecal incontinence, respectively, adjusted odds ratio (aOR) 2.3 (95% confidence interval [CI], 0.7-7.0), p = .147 and in women with defect versus intact EAS, 36% and 9% had fecal incontinence, aOR 4.0 (95% CI, 1.5-10.8), p = .005. In women with defect and intact IAS, 85% versus 43% reported flatal incontinence, aOR 5.2 (95% CI, 1.6-17.2), p = .007 and in women with defect versus intact EAS, 71% versus 43% had flatal incontinence, aOR 1.9 (95% CI, 0.8-4.5), p = .131. Conclusions: One of four women scheduled for POP surgery had an anal sphincter defect. EAS defects were associated with fecal incontinence and IAS defects were strongly associated with flatal incontinence.

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Anal sphincter defects and fecal incontinence 15–24 years after first delivery: a cross‐sectional study

Cited by 39 publications

References 36 publications

Levator ani muscle injury and risk for urinary and fecal incontinence in parous women from a normal population, a cross‐sectional study

Levator ani muscle injury and risk for urinary and fecal incontinence in parous women from a normal population, a cross‐sectional study

Anal Sphincter Length as Determined by 3‐Dimensional Endoanal Ultrasound and Anal Manometry

Prevalence of anal sphincter defects and association with anal incontinence in women scheduled for pelvic organ prolapse surgery

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