Anal incontinence and quality of life following obstetric anal sphincter injury

Abstract

The objective of our study was to identify the number of women who have long-term ano-rectal symptoms following primary repair of obstetric anal sphincter injury (OASI) and the effect on their quality of life. We also wished to determine the impact of the injury on decision for future pregnancies and mode of delivery in subsequent pregnancies. A cohort of women who sustained OASI in 2004 in Ninewells Hospital were contacted (minimum 4 years post-repair). They were sent a questionnaire about incontinence of flatus, solid stools, liquid stools, severity of incontinence, quality of life, decision for future pregnancy and mode of delivery in subsequent pregnancy. 70/4,245 (1.7%) women sustained OASI. 42/70 (60%) women responded to the questionnaire. 15/41 (37%) experienced anal incontinence. 8/15 (53%) women had to alter their lifestyle due to their symptoms. Women who were asymptomatic had a median visual analogue score of 0.5 (range 0-4) and women who were symptomatic had a median score of 3.5 (range 2-8). 12/41 (29%) decided against further pregnancies and 8 of them were symptomatic (p 0.015). 16/41 women (39%) did not have any further pregnancy following OASI and 9 of them (56%) had anal incontinence. Of the 25 women who did have further pregnancies, 6 women (24%) had anal incontinence. 19 of them were asymptomatic. (p = 0.03). 5 out of the 6 symptomatic women had elective caesarean sections. Long-term outcomes following OASI are not encouraging. A significant number of women decided against further pregnancy and most symptomatic women that have further pregnancy opt to deliver by caesarean section.