Fecal incontinence after obstetric anal sphincter injuries

Huebner, Markus; Gramlich, Nathanja K.; Rothmund, Ralf; Nappi, Luigi; Abele, Harald; Becker, Sven

doi:10.1016/j.ijgo.2012.10.023

Cited by 32 publications

(22 citation statements)

References 24 publications

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“…As no RCTs were identified, this is based on data from 27 cohort and case control NRSs, across nine countries, predominantly with methodological inadequacies (data provided for 1,781 of the 3,297 women where data relating to subsequent births following OASIS were available) [4,[35][36][37][38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

“…In our clinical experience, there is a wide variation between individual women with regard to their choice of mode of subsequent birth. Some are prepared to pursue another vaginal birth, despite evidence suggesting that the risk of an OASIS in a subsequent vaginal birth might be greater than for women with no previous history of OASIS [4], although other women request a caesarean section irrespective of health practitioner advice. Interestingly, the study by Bondili et al [25], found improvements in AI in symptomatic women recommended to undergo subsequent elective caesarean section.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective cohort study of 125 women with matched controls, De Leeuw et al [18] reported that for women with previous OASIS there was no association between AI and having a subsequent vaginal birth or not (41% vs 39% respectively; OR 2.32; 95% CI 0.85-6.33; p = 0.10). A retrospective follow-up NRS (mean 27.5 years ± 2.4) of 99 women with OASIS from their first birth by Huebner et al [4] also found no association between parity irrespective of mode and anal incontinence of either liquid/solid stool (OR 1.69; 95% CI 0.58-4.97; p = 0.335) or flatus (OR 2.25; 95% CI 0.94-5.41; p = 0.067). Likewise, in their study of women with OASIS and matched controls (mean follow-up 22.2 years), Soerensen et al [19] found no association between long-term AI and having a subsequent birth in women with third-or fourth-degree OASIS.…”

Section: Subsequent Birth Vs No Subsequent Birth (Irrespective Of Mode)mentioning

confidence: 99%

“…For these women and in the absence of an obvious sphincter defect on ultrasound, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends discussion and consideration of all modes of birth, based on limited, low level 4 evidence [3]. Indeed, data show that, before consideration of AI symptoms, over 60% of women with previous OASIS would prefer a subsequent vaginal birth [4,5]. Therefore, the majority of women seem to be keen to avoid Electronic supplementary material The online version of this article (doi:10.1007/s00192-016-3226-y) contains supplementary material, which is available to authorized users unnecessary major surgical intervention, such as caesarean section, although a significant number are still cautious about pursuing another vaginal birth that could result in further damage to the pelvic floor and long-term AI.…”

Section: Introductionmentioning

confidence: 99%

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Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis

et al. 2016

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Introduction and hypothesis Obstetric anal sphincter injuries (OASIS) are serious complications of vaginal birth. In a pregnancy following OASIS women may be keen to avoid an elective caesarean section, yet cautious about pursuing another vaginal birth that may result in further damage to the pelvic floor and possible long-term anal incontinence. This review aimed to evaluate the impact of subsequent birth and its mode on anal incontinence (AI) and/or quality of life (QoL), for women with previous OASIS. Methods Searches of MEDLINE, EMBASE, CINAHL, and AMED from inception to February 2016 were undertaken with selection criteria of any study evaluating the effect of a subsequent birth on AI and/or QoL in women with previous OASIS. Where possible, data were extracted to populate 2 × 2 tables and allow meta-analysis relating to the impact of subsequent birth on AI and/or QoL. Results Twenty-seven non-randomised studies were included. Meta-analysis of 14 studies (977 women) did not demonstrate any significant associations between AI in women with previous OASIS and subsequent birth or its mode. Impact on QoL was reported in 12 studies (912 women); however, difference in outcome reporting precluded data meta-analysis. Conclusions Comparisons of outcomes and effective synthesis were limited by sample size, quality and heterogeneity of the studies included. Consequently, the optimal mode of delivery for women with previous OASIS is still not known and better data are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Subsequent Birth Vs No Subsequent Birth (Irrespective Of Mode)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis

et al. 2016

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“…3). It is well known that many anal sphincter injuries are asymptomatic until the 5th decade of life [28,29]. Could the patients with lower manometric pressure be those who will develop symptoms in the future?…”

Section: Discussionmentioning

confidence: 99%

Alteration of anal sphincter function in patients with levator avulsion: observational study

et al. 2015

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Prevalence and predictors of anal incontinence 6 years after first delivery

Johannessen

Stafne

Falk

et al. 2018

Neurourology and Urodynamics

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Aims:The main aim of the present study, was to explore prevalence and predictors of anal incontinence (AI) experienced 6 years after first delivery. Methods: In this longitudinal prospective cohort study, participants in a previous study answered questions about AI 6 years after first delivery using postal or digital questionnaires. Prevalence of AI was calculated, and multivariable logistic regression analyses were applied. Results: A total of 731 (48%) of the original participants who gave birth to their first child between May 2009 and December 2010 responded 6 years after first delivery.There was a significant reduction in reports of one or more AI symptoms from late pregnancy (33%; 95%CI: 30.3, 37.2) to 6 years after first delivery (21%; 95%CI:18.4, 24.4, P = 0.028). Older age at first delivery, BMI (≥35), active bowel disease, and previous problems with bowel evacuation and urgency when going to the toilet predicted AI at 6 years. Long-term AI was also associated with instrumental first delivery (Odds ratio (OR):1.8; 95%CI:1.1, 2.8) and sustaining a perianal tear grade three or four at first delivery (OR:3.0; 95%CI:1.3, 6.8).Conclusions: Prevalence of AI was significantly reduced from late pregnancy, still 21% experienced AI 6 years after first delivery. Findings from the present study indicate that an added focus on modifiable risk factors for AI such as BMI, OASIS and history of PFDs increase the risk of AI in the long term, may be beneficial in reducing incontinence problems the short-and long-term.

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Fecal incontinence after obstetric anal sphincter injuries

Abstract: Operative vaginal delivery was significantly associated with fecal but not flatal incontinence. No other obstetric variables tested were associated with the long-term prevalence of fecal or flatal incontinence.

Cited by 32 publications

References 24 publications

Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis

Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis

Alteration of anal sphincter function in patients with levator avulsion: observational study

Prevalence and predictors of anal incontinence 6 years after first delivery

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