Irritable bowel syndrome worsens faecal incontinence after primary repair of major obstetric anal sphincter injuries (OASIS): a prospective cohort study

Abstract

Objective: Obstetric anal sphincter injuries (OASIS) occur in approximately 3-6% of vaginal deliveries and are the leading risk factor for late onset faecal incontinence. We aimed to assess the effect of irritable bowel syndrome (IBS) on severity of faecal incontinence after immediate primary repair of major OASIS (Grade IIIb-IV). Design: Prospective cohort study Setting: Zaans Medisch Centrum, Zaandam, The Netherlands Population: Women who underwent a primary repair of major OASIS over a 2-year period (Group A), a control group consisting of primigravid women (Group B), and another control group who underwent elective Caesarean section (Group C). Methods: Participants were assessed with ultrasonography within 12 weeks, then a follow-up questionnaire after at least 12 months. Main outcome: Wexner faecal incontinence scores and presence of IBS based on Rome IV criteria. Results: There were 211 total patients included, and mean follow-up time was 26 months after sphincter repair. Ultrasonographic sphincter defects were detected in 37% but did not affect faecal incontinence score (p=0.16). Patients with IBS had significantly worse faecal incontinence (p<0.001), and interestingly in women with OASIS those without IBS had comparable symptoms to the control groups. Inability to defer defaecation for 15 minutes was also associated with worse faecal incontinence (p=0.003). Conclusion: After OASIS repair faecal incontinence was significantly worsened by the presence of IBS, or in women with an inability to defer defaecation. Presence of ultrasonographic sphincter defects did not correlate to a clinical difference in faecal incontinence scores. Funding: Nil. Keywords: OASIS, sphincter, irritable bowel syndrome, incontinence

The monkey chased the weasel: is it irritable bowel syndrome or faecal incontinence we find following obstetric anal sphincter injuries?

“…So it is that Sarofim et al. 's [2] paper published online in January 2024 in Colorectal Disease provides food for thought regarding the relationship of irritable bowel syndrome (IBS) and faecal incontinence (FI) following primary repair of major obstetric anal sphincter injuries (OASIS). Just like finding out that ‘Pop goes the Weasel’ is a tune from 1854 that was a favourite of Queen Victoria and that the tune came first, and then the stanzas, unless you accept the possibility that the words may be 400 years old and then the whole thing got transferred and altered by word of mouth across the Atlantic, takes time, patience, clarity and continually checking your bearings [3].…”

Pragmatic or pristine surgical research

“…Dear Editor, We read with interest the exegetical commentary in Colorectal Disease which offered a peer-reviewer's perspective [1] on our research into the relationship of irritable bowel syndrome (IBS) and primary repair of major obstetric anal sphincter injuries (OASIS) on the outcome of faecal incontinence [2]. It is most important to say from the outset that we appreciate the constructive feedback from this author during the submission process, and credit them for taking the time to subsequently provide their encouraging thoughts.…”