Open AccessComplete rupture of anal sphincter in primiparas: long‐term effects and subsequent delivery
Author(s) -
WEGNELIUS GISELA,
HAMMARSTRÖM MARGARETA
Publication year - 2011
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/j.1600-0412.2010.01037.x
Subject(s) - medicine , vaginal delivery , anal sphincter , childbirth , pelvic floor , fecal incontinence , external anal sphincter , pelvic floor dysfunction , obstetrics , surgery , sphincter , gynecology , pregnancy , anal canal , rectum , genetics , biology
Objective. To study long‐term effects with respect to anal incontinence, pain, attitude to and mode of second delivery following complete rupture of the anal sphincter. Design. Case‐control study. Settings. Södersjukhuset, a university hospital in Stockholm. Population. A case group of 136 primiparas who had experienced a complete rupture of the anal sphincter. Two matched control groups of primiparas, one of whom had cesarean section and the other a normal vaginal delivery. Methods. The case women were examined and asked for symptoms of anal incontinence 3–6 months after delivery; 3–8 years later they and two matched control groups answered a postal questionnaire. Response rate was 89%. Main outcome measures. Symptoms of pelvic floor dysfunction and, as secondary end‐point, the attitude to and mode of second delivery. Results. Anal incontinence after delivery was reported by 31% in the case group, and at long‐term follow‐up by 54% in the case group, 21% in the cesarean section and 23% in the normal delivery group ( p < 0.0001). A wish to postpone or abandon further childbirth was significantly more common in the case women (33 and 18%) than in the other groups, but about 60% delivered again in all groups. In the case group, the next delivery was by cesarean section in 49%. Conclusion. At long‐term follow‐up after a complete rupture of the anal sphincter, anal incontinence was common and many women wished to postpone or avoid further delivery.