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Obstetric anal sphincter injury ten years after: subjective and objective long term effects
Author(s) -
Fornell Eva Uustal,
Matthiesen Leif,
Sjödahl Rune,
Berg Göran
Publication year - 2005
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2004.00400.x
Subject(s) - medicine , endoanal ultrasound , sphincter , anorectal manometry , anal sphincter , prospective cohort study , external anal sphincter , anal canal , vaginal delivery , surgery , fecal incontinence , internal anal sphincter , population , defecation , rectum , pregnancy , environmental health , biology , genetics
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.