Predicting anal sphincter defects: the value of clinical examination and manometry

Roos, Anne‐Marie; Abdool, Zeelha; Thakar, Ranee; Sultan, Abdul H.

doi:10.1007/s00192-011-1609-7

Cited by 21 publications

(10 citation statements)

References 26 publications

(44 reference statements)

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“…IAS defects have been independently correlated with severe anal incontinence symptoms. These results concur with those of previous studies, highlighting the importance of the accurate diagnosis of IAS injuries and adequate repair. Structured hands‐on training workshops have been shown to improve a doctor's ability to identify and repair OASIS.…”

Section: Discussionsupporting

confidence: 84%

Overdiagnosis and rising rate of obstetric anal sphincter injuries (OASIS): time for reappraisal

Sioutis

Thakar

Sultan

2017

Ultrasound in Obstet & Gyne

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Seven percent of women with a clinical diagnosis of OASIS were wrongly diagnosed. We believe that this rate may differ from that of other units but training methods and competency assessment tools for the diagnosis and repair of OASIS need urgent reappraisal. The role of EA-US in the immediate postpartum period needs further evaluation as the accurate interpretation of the images is dependent on the expertise of the staff involved. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionsupporting

confidence: 84%

Overdiagnosis and rising rate of obstetric anal sphincter injuries (OASIS): time for reappraisal

Sioutis

Thakar

Sultan

2017

Ultrasound in Obstet & Gyne

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“…18 Additionally, a prospective cohort found an increased risk of anal sphincter injury if the PBL was < 3 cm. 19 However, another study found that PBL and pelvic floor muscle strength were not predictive of sphincter trauma, 20 and prospective data from a nulliparous cohort of women at our institution demonstrated no correlation between antepartum PBL and perineal tearing. 9 …”

Section: Discussionmentioning

confidence: 68%

“…It has been indicated that a short PBL is related to sonographic anal sphincter defects, 19 which are correlated to postpartum FI in some studies 1–2,20 but ultrasound findings are inconsistent predictors of postpartum FI pathology. 21,22 This indicates that anatomic changes, or even damage, do not always result in poor function.…”

Section: Discussionmentioning

confidence: 99%

Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study

Meriwether

Rogers

Dunivan³

et al. 2016

Int Urogynecol J

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Introduction The perineum stretches naturally during obstetrical labor, but it is unknown if this stretch has a negative impact on pelvic floor outcomes after a vaginal birth (VB). We aimed to evaluate whether perineal stretch was associated with postpartum pelvic floor dysfunction. Materials and Methods This was a prospective cohort study of primiparous women who had a VB. Perineal body (PB) length was measured antepartum, during labor, and 6 months postpartum. We determined the maximum PB (PB Max) measurements during the second stage of labor and PB change (ΔPB) between time points. Women completed functional questionnaires and had a POP-Q exam 6 months postpartum. We analyzed the relationship of PB measurements to perineal lacerations and postpartum outcomes including urinary, anal, or fecal incontinence, sexual activity and function, and POP-Q measurements. Results 448 women with VB had a mean age of 24 ± 5.0 years and rare (5%) third or fourth degree lacerations. During the second stage of labor, 270/448 (60%) had perineal measurements. Mean antepartum PB length was 3.7 ± 0.8 cm with a maximum mean PB length (PB Max) during the second stage of 6.1 ± 1.5 cm, an increase of 65%. The change in PB length (ΔPB) from antepartum to 6 months postpartum was a net decrease (−0.39 ± 1.02 cm). PB at any time point and PB Max were not associated with perineal lacerations or outcomes postpartum (all p>0.05). Discussion PB stretch during labor is unrelated to perineal laceration or postpartum incontinence, sexual activity, or sexual function.

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“…This is disputed by Hallan et al , 22 who found DRE to be statistically equal in ability to ARM at predicting anal tone. In contrast, the study of Eckardt and Kanzler 21 suggests a higher sensitivity (ranging from 68% to 84%) and lower specifi city (57%), comparable with Roos et al , 25 who found the sensitivity of DRE to be 67% and specifi city 55% and proposed that manometry has a greater accuracy in detecting anal defects. The majority of the literature therefore fi nds DRE results to be inconsistent in accuracy and therefore not a reliable tool.…”

Section: Accuracymentioning

confidence: 64%

The Evaluation of Digital Rectal Examination for Assessment of Anal Tone in Suspected Cauda Equina Syndrome

Sherlock

Turner

Elsayed

et al. 2015

Spine

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Predicting anal sphincter defects: the value of clinical examination and manometry

Abstract: Clinical assessment has a poor sensitivity for detecting anal sphincter defects. The proposed manometric cut-off values can be used to either reassure or identify women who may need further assessment by EAU.

Cited by 21 publications

References 26 publications

Overdiagnosis and rising rate of obstetric anal sphincter injuries (OASIS): time for reappraisal

Overdiagnosis and rising rate of obstetric anal sphincter injuries (OASIS): time for reappraisal

Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study

The Evaluation of Digital Rectal Examination for Assessment of Anal Tone in Suspected Cauda Equina Syndrome

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