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Clinical consequences of anal sphincter rupture during vaginal delivery
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 Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
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1996 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 183, no 6, 553-558 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to meet women with anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth.

STUDY DESIGN:

Fifty-one consecutive women with primarily sutured anal sphincter rupture and 31 women without anal sphincter rupture were prospectively studied after vaginal delivery. All were assessed clinically at 3 days, 6 weeks, and 6 months after delivery. After 6 months, all women underwent anorectal manometry and answered a questionnaire about incontinence, social function, and general health.

RESULTS:

The overall incidence of sphincter rupture was 2.4 percent. Significantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture. The resting pressures did not differ between groups. Approximately 40 percent of the women in both groups had noted some fecal incontinence by 6 months postpartum. Symptoms were significantly more severe in patients with sphincter rupture.

CONCLUSIONS:

Anal sphincter rupture was 2.4 times as common as reported in Swedish birth statistics. The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.

Place, publisher, year, edition, pages
1996. Vol. 183, no 6, 553-558 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-84646PubMedID: 8957456OAI: oai:DiVA.org:liu-84646DiVA: diva2:560943
Available from: 2012-10-16 Created: 2012-10-16 Last updated: 2017-12-07Bibliographically 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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Berg, GöranMatthiesen, Leif S.Sjödahl, Rune

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