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Abstract
PurposeObstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life.Material and methodsBetween 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction.ResultsA high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire.ConclusionOn one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems.
Highlights
Many women suffer from pelvic floor disorders following pregnancy and delivery, which may occur immediately after birth or many years later
Some studies have shown that the highest risk for pelvic floor dysfunction, including a high risk for flatus or stool incontinence, is a delivery with an obstetric anal sphincter injuries (OASIS) [19, 31]. This is in contrast to the study of Nygaard et al They carried out a 30-year retrospective study with the focus on anal incontinence after OASIS with two control groups
In the delivery protocol only in 21 cases the OASIS was further subdivided into grade A (14 cases), grade B (5 cases) and grade C (3 cases)
Summary
Many women suffer from pelvic floor disorders following pregnancy and delivery, which may occur immediately after birth or many years later. It is known that up to 33% suffer of urinary incontinence and 10% from stool incontinence after delivery [11], and up to two thirds of women develop a pelvic floor prolapse over time [5, 32] All of these pelvic floor dysfunctions can have a serious impact on the quality of life and should be detected, treated and if–possible–prevented. The influence of obstetric anal sphincter injuries (OASIS) on the long-term prevalence of urinary incontinence, pelvic floor prolapse or sexuality has barely been studied, and the results of the few existing studies are contradictory. The goal of our study was to retrospectively analyze quality of life and pelvic floor function of women in long-term follow-up after an OASIS event during vaginal birth and to compare the results of a clinical examination with self-reported pelvic floor function disorders
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