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Obstetric anal sphincter injury ten years after: subjective and objective long term effects
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
2005 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 112, no 3, 312-316 p.Article in journal (Refereed) Published
Abstract [en]

Objective  To establish the long term effects of obstetric anal sphincter rupture.

Design  Prospective observational study.

Setting  University hospital in Sweden.

Population  Eighty-two women from a prospective study from 1990 to compare anorectal function after third degree tear.

Methods  Women completed a structured questionnaire, underwent a clinical examination and anorectal manometry, endoanal ultrasound (EAUSG) with perineal body measurement.

Main outcome measures  Symptoms of anal incontinence, sexual symptoms, anal manometry scores and evidence of sphincter damage on EAUSG.

Results  Five women had undergone secondary repair and three were lost to follow up. Fifty-one women (80%) completed the questionnaire. Twenty-six out of 46 (57%) of the original study group and 6/28 (20%) of the original controls were examined. Incontinence to flatus and liquid stool was more severe in the study group than in controls. Flatus incontinence was significantly more pronounced among women with subsequent vaginal deliveries. Mean maximal anal squeeze pressures were 69 mmHg in the partial rupture group and 42 mmHg in the complete rupture group (P= 0.04). Study group women with signs of internal sphincter injury reported more pronounced faecal incontinence and had lower anal resting pressures (24 mmHg) than those with intact internal sphincters (40 mmHg) (P= 0.01). Perineal body thickness of less than 10 mm was associated with incontinence for flatus and liquid stools, less lubrication during sex and lower anal squeeze pressures (58 mmHg vs 89 mmHg, P= 0.04).

Conclusions  Subjective and objective anal function after anal sphincter injury deteriorates further over time and with subsequent vaginal deliveries. Thin perineal body and internal sphincter injury seem to be important for continence and anal pressure.

Place, publisher, year, edition, pages
2005. Vol. 112, no 3, 312-316 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-24618DOI: 10.1111/j.1471-0528.2004.00400.xLocal ID: 6797OAI: oai:DiVA.org:liu-24618DiVA: diva2:244940
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Pelvic floor dysfunction: a clinical and epidemiological study
Open this publication in new window or tab >>Pelvic floor dysfunction: a clinical and epidemiological study
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In a prospective study established in 1990, anal sphincter rupture at delivery was found in 2.4% of women and 47% of these women had problems with fecal incontinence. Although less severe, fecal incontinence was also found among 45% in a comparison group without anal sphincter rupture. In a follow-up study after ten years, no improvement was noted in either group. Women with anal sphincter rupture were more subjectively incontinent and had lower anal pressures than the comparison group. Women with subsequent vaginal deliveries had lower anal pressures and more incontinence than those delivered by caesarean section or no subsequent delivery.

In an epidemiological study of 1368 women, urinary incontinence was found in 9% of 40-year-olds and 19% of 60-year-olds. Flatus incontinence was found in 9% and 19%, incontinence for liquid stool in 5% and 8% and for solid stool 0.3% and 1. 7% in 40-year-olds and 60-year-olds, respectively. Genital prolapse symptoms were found in 4% (genital bulge), 15% (pelvic heaviness) and use of finger in vagina or perineum by defecation (12%) in all women.

Factors associated with urinary and fecal incontinence were anal sphincter rupture, chronic bronchitis, overweight, multiparity, age, hiatus and groin hernias and hysterectomy. Prolapse symptoms were associated with vaginal delivery and large tears at delivery but not with overweight. All types of incontinence and genital prolapse were strongly associated with each other.

For epidemiological studies, the definition of urinary incontinence as leakage weekly or more often is suggested. The concept of flatus incontinence needs careful operationalization to be of value in differentiating symptoms of anal sphincter dysfunction from disorders of bowel motility and normal passing of wind. A model for operationalization is proposed. Possible measures for the prevention of PFD could be prevention of chronic bronchitis, overweight and large injuries at delivery, especially after large tears and anal sphincter rupture.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2003. 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 822
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26675 (URN)11242 (Local ID)91-7373-511-6 (ISBN)11242 (Archive number)11242 (OAI)
Public defence
2003-11-14, Victoriasalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-16Bibliographically approved

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Uustal Fornell, EvaMatthiesen, LeifSjödahl, RuneBerg, Göran

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