St. Mark’s incontinence score for assessment of anal incontinence following obstetric anal sphincter injuries (OASIS)

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

doi:10.1007/s00192-008-0784-7

Cited by 60 publications

(50 citation statements)

References 17 publications

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“…The St Mark's incontinence (SMIS) scoring system was used for faecal incontinence: a total score was calculated adding up the separate scores of frequency of faecal urgency, faecal incontinence, flatus incontinence and impact on lifestyle (range 0-24). 36,37 The International Consultation Incontinence Questionnaire Short Form (ICIQ-SF) was used for urinary incontinence: a total score was calculated including frequency, amount that leaks and interference with everyday life (range 0-21) and urinary incontinence was defined as ICIQ-SF >0, and sub analysis was performed to assess when urine leaks. 38 ICIQ-VS was used for vaginal symptoms and sexual matters and all subscales of this questionnaire were analysed separately.…”

Section: Methodsmentioning

confidence: 99%

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Delft

Sultan

Thakar

et al. 2014

BJOG

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Objective To establish the relationship between postpartum levator ani muscle (LAM) avulsion and signs and/or symptoms of pelvic floor dysfunction (PFD).Design Observational longitudinal cohort study.Setting District General University Hospital, UK.Population or sample Primigravida at 36 weeks' gestation and 3 months postpartum.Methods Pelvic floor muscle strength (PFMS) and pelvic organ prolapse were assessed clinically using validated methods. Transperineal ultrasound was performed to identify LAM avulsion and measure hiatus dimensions. Validated questionnaires evaluated sexual function, urinary and faecal incontinence.Main outcome measures PFD signs and symptoms related to LAM avulsion.Results Two hundred and sixty nine primigravida without LAM avulsion participated and 71% (n = 191) returned postpartum. LAM avulsion was found in 21% of vaginal deliveries (n = 30, 95%CI 15.1-28.4%). Women with minor and major avulsion had worse PFMS (P < 0.038) and more anterior compartment prolapse (maximum stage 2; P < 0.024). Antenatal hiatus antero-posterior diameter on ultrasound was significantly smaller in women sustaining avulsion (P = 0.011). Postnatal measurements were significantly increased following avulsion. Women with major avulsion were less sexually active at both antenatal and postnatal periods (P < 0.030). These women had more postnatal urinary incontinence and symptoms such as reduced vaginal sensation and 'too loose vagina'. No postnatal differences were found for faecal incontinence, prolapse symptoms or quality of life. The correlation of differences in variables was only slight-fair with avulsion severity.Conclusions Twenty one percent of women sustain LAM avulsion during their first vaginal delivery with significant impact on signs and symptoms of PFD. As avulsion has been described as the missing link in the development of prolapse; longer term follow-up is vital.Keywords Childbirth, incontinence, levator ani avulsion, pelvic floor dysfunction, pelvic organ prolapse, transperineal ultrasound.Please cite this paper as: van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction.

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Section: Methodsmentioning

confidence: 99%

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Delft

Sultan

Thakar

et al. 2014

BJOG

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“…Substantial faecal incontinence was defined as a St Mark's incontinence score of more than 8 and weekly faecal incontinence episodes despite optimal conservative management [12]. The St Mark's score has been shown to correlate with quality of life in women with a history of OASIS [13] and a score greater than 8 has been shown to be associated with a reduced quality of life [14]. Conservative treatment included at least 6 months of tailored management with supportive devices, including paddings and plugs, dietary modification, constipating medication, pelvic floor exercises with or without biofeedback and transanal irrigation.…”

Section: Methodsmentioning

confidence: 99%

“…The ICIQ-UI-SF was designed to measure the severity of symptoms of urinary incontinence and its impact on lifestyle. ICIQ-UI-SF ranges from 0 (continent) to 21 (complete urinary incontinence) and is graded from mild (1-5), moderate (6)(7)(8)(9)(10)(11)(12), severe (13)(14)(15)(16)(17)(18) to very severe (19)(20)(21). In addition to the numerical scale, the ICIQ-UI-SF contains seven questions defining stress and urinary urge incontinence.…”

Section: Methodsmentioning

confidence: 99%

Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury

et al. 2018

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Aim The aim of this study was to investigate the efficacy of sacral neuromodulation (SNM) in the treatment of faecal incontinence and concomitant urinary incontinence in women with a history of obstetric anal sphincter injury (OASIS).Method In this prospective study, consecutive women with faecal incontinence following OASIS accepted for SNM were screened for concomitant urinary incontinence. The primary outcome was the change in urinary incontinence score on the International Consultation on Incontinence Questionnaire for Urinary Incontinence, Short Form (ICIQ-UI-SF), between baseline and 12 months. Secondary outcomes included the change in St Mark's score, sexual function and quality of life, change in grade of urinary incontinence and disappearance of urgency.Results From March 2012 to September 2014, 39 women with combined faecal incontinence and urinary incontinence received SNM. Thirty-seven women were available for analysis after 12 months. The mean reduction in the ICIQ-UI-SF score between the baseline and 12 months was 5.8 (95% CI 3.7-8.0, P < 0.001). ICIQ-UI-SF was reduced in 29 (78%) women, urinary incontinence resolved in 13/37 (35%, 95% CI 20%-50%) patients, and urgency disappeared in 14/33 (42%, 95% CI 26%-59%). The mean reduction in the St Mark's score was 10.6 (95% CI 8.6-12.7, P < 0.001). Disease-specific quality of life, Euroqual 5-dimension visual analogue scale (EQ-5D VAS) and several areas of sexual function changed significantly for the better.Conclusion More than three-quarters of the women with combined faecal and urinary incontinence following OASIS reported a successful outcome with reduction in ICIQ-UI-SF at 12 months after SNM.Keywords Faecal incontinence, urinary incontinence, pelvic floor disorders/dysfunction, obstetric anal sphincter injury, sacral neuromodulation What does this paper add to the literature? A high prevalence of concomitant urinary incontinence was found in a selected group of women with faecal incontinence following obstetric anal sphincter injury treated with sacral neuromodulation. Faecal incontinence and concomitant urinary incontinence were treated successfully in the majority of women.

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“…Clinically derived measuring tools have been developed to assess and measure the impact of AI on quality of life; however, they have been largely unsuccessful. A variety of scoring systems such as the Cleveland, Wexner and St Marks incontinence score (Vaizey score) have been developed to quantify and objectively assess the physical impact of AI on a person's life . The Vaizey score is a reliable and objective assessment tool in the identification of severity and impact of AI.…”

Section: Assessing Quality Of Lifementioning

confidence: 99%

“…The Vaizey score is a reliable and objective assessment tool in the identification of severity and impact of AI. The Vaizey score is superior to other symptom severity scores as it is easy to implement and includes two quality of life areas, that is the frequency of wearing incontinence pads and impact on lifestyle . However, the Vaizey score is unable to provide in‐depth information as to the impact of AI on a person's quality of life.…”

Section: Assessing Quality Of Lifementioning

confidence: 99%

Womenʼs experience of anal incontinence following a history of obstetric anal sphincter injury: a literature review

Tucker¹,

Wilson²,

Clifton³

2013

International Journal of Evidence-Based Healthcare

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Background Anal incontinence (AI) is the involuntary loss of a liquid or solid stool and flatus, resulting in a lifelong profound negative impact on a person's quality of life. One million Australians, half of whom are women, are affected by AI. The aetiology of AI is reported within research literature. Importantly obstetric anal sphincter injury following vaginal delivery is a predominant cause of AI. Factors cited as major risk factors of anal sphincter damage include instrumental delivery, macrosomia and primiparity. The incidence of AI increases with age and with further vaginal delivery. The impact lasts for life. Aim This study aims to identify women's experiences of AI following obstetric anal sphincter injury and their impact on quality of life. Method An extensive online literature search was undertaken within the medical and nursing databases including the Cumulative Index of Nursing and Allied Health Literature, Scopus, PubMed and Medline. Key search terms included AI, faecal incontinence, anal sphincter injuries, obstetric complications, trauma, obstetric, postnatal care, experiences, women's experience and quality of life. The literature search was further refined through fields that included English language only, literature published between 2000 and 2012 and full‐text articles. Findings The review identified a significant amount of research literature that addressed the prevalence and cause of AI. While quality of life questionaries and symptom severity scores have been utilised to assess the impact of AI on a person's life, there are inherent weaknesses in providing the experience of AI on a person's life. Furthermore, there is limited in‐depth research that addresses women's experiences of AI following a history of obstetric anal sphincter injury and the impact on their quality of life. Conclusion Research findings contribute to understanding the prevalence, physical, social and emotional impact of AI. While alterations in clinical practice can improve the identification and management of AI, further research that builds on the state of knowledge and seeks a deeper understanding of the issues for women with AI as a result of obstetric anal sphincter injury is required.

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St. Mark’s incontinence score for assessment of anal incontinence following obstetric anal sphincter injuries (OASIS)

Cited by 60 publications

References 17 publications

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury

Womenʼs experience of anal incontinence following a history of obstetric anal sphincter injury: a literature review

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