Objective methods cannot predict anal incontinence after primary repair of extensive anal tears

Abstract

A majority of women with primarily repaired anal sphincter ruptures at delivery were incontinent. Sphincter defects and signs of neuropathy could not precisely predict symptoms.

The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence

“…Others studying incontinence at 3-12 months or at 1-5 years after primary repair of an obstetric sphincter tear found similar results with 40-59% of the women having anal incontinence 2,6,9,11,12,21 . In our study the incontinence score increased with time.…”

“…According to published studies, most women with anal incontinence after an obstetric sphincter tear are incontinent for gas only (gas incontinence/stool incontinence ratio of 5 : 1) 8,12,21,28 . In a 30-year retrospective study of women in three groups (obstetric anal sphincter tear, episiotomy, Cesarean delivery) 16 a surprisingly large number of middle-aged women had anal incontinence.…”

“…This might be explained by the small number of women with fourth-degree tears. Conversely, an unequivocal relationship between clinical type of tear and subsequent type of anal incontinence has not been established 21,24,27 .…”

“…Not all women with endosonographic sphincter defects have anal incontinence (i.e. incontinence for solid or liquid stool) or flatus incontinence 14,21 . The discrepancy might be explained by minor sphincter defects not resulting in anal incontinence, or by anal incontinence not developing until many years -perhaps as many as 20-30 years -after the tear.…”

Analysis of seconder anal sphincter repair in patients with faecal incontinence

“…In the presence of obstetric anal sphincter damage, it is inevitable to see anal incontinence in the cases in which this damage cannot be detected. Unfortunately, in the cases in which sphincter damage was detected, the likelihood of anal incontinence following primary repair was stated to be 50% and above (5,14) . These patients with undetectable occult obstetric anal sphincter damage or with the findings of anal incontinence despite primary repair undergo secondary repair in the late stage.…”