Abstract
BackgroundAim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed.MethodsAll women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark’s incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography.ResultsIn total 52,3% (n = 207) of the 396 invited women participated in the study. Mean St. Mark’s score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury.ConclusionThe prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark’s incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment.
Highlights
Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed
Study participants were recruited between November 2016 and April 2017
None had fecal leakage as often as weekly. 11.7% suffered from fecal urgency
Summary
Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed. The prevalence of anal incontinence among women who sustained OASIS 1–5 years previously has Studies show a prevalence of 0,5–5% recognized obstetric anal sphincter injuries (OASIS) [5, 8, 9]. In Norway, the prevalence of recognized OASIS has decreased in recent years [8] and was diagnosed in 1.8% of all vaginal deliveries between 2015 and 2016 according to the Medical Birth Registry in Norway [10]. Andrews et al showed that most unrecognized OASIS are detectable by re-examination by trained examiners, the prevalence of OASIS in their study of 254 vaginal deliveries increased from 11% to 24,5% when women were re-examined. In another study by Groom et al increased vigilance improved the diagnosis of OASIS from 2,5% recognized injuries prior to the intervention study, to 9,3% during the intervention period [12]
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