Okeahialam, NA; Thakar, R; Naidu, M; Sultan, AH
(2020)
Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)-a nested case-controlled study.
Int Urogynecol J, 31 (11).
pp. 2405-2410.
ISSN 1433-3023
https://doi.org/10.1007/s00192-020-04377-3
SGUL Authors: Sultan, Abdul Hameed
Abstract
INTRODUCTION AND HYPOTHESIS: Obstetric anal sphincter injury (OASI) is a significant risk factor for developing anal incontinence. It can therefore be hypothesised that recurrent OASI in a subsequent delivery may predispose women to further anal sphincter dysfunction. METHODS: A nested case-controlled study based on data collected prospectively between 2006 and 2019. Women matched for age and ethnicity, with a history of one OASI and no sphincter damage in a subsequent delivery (control) were compared to women sustaining a second OASI. Assessment was carried out using the St Mark's score (SMIS), anorectal manometry and endoanal ultrasound scan (findings quantified using the modified Starck score). RESULTS: Eighty-four women were included and equally distributed between the two groups, who were followed up 12 weeks postnatally. No difference in SMIS scores was found. Maximum resting pressure (MRP, mmHg) and maximum squeeze pressure (MSP, mmHg) were significantly reduced in the study group. Median (IQR) MRP in the study group was 40.0 (31.3-54.0) versus 46.0 (39.3-61.5) in the control group (p = 0.030). Median (IQR) MSP was 73.0 (58.3-93.5) in the study group versus 92.5 (70.5-110.8) (p = 0.006) in the control group. A significant difference (p = 0.002) was found in the modified Starck score between the study group (median 0.0 [IQR 0.0-6.0]) and control group (median 0.0 [IQR 0.0-0.0]). CONCLUSIONS: We have demonstrated that women with recurrent OASI do not have significant anorectal symptoms compared to those with one OASI 12 weeks after delivery, but worse anal sphincter function and integrity. Therefore, on long-term follow-up, symptoms may possibly develop. This information will be useful when counselling women in a subsequent pregnancy.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2020
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
Keywords: |
Anal incontinence, Anorectal manometry, Endoanal ultrasound, Obstetric anal sphincter injuries, Perineal trauma, Recurrent obstetric anal sphincter injury, Obstetrics & Reproductive Medicine, 1114 Paediatrics and Reproductive Medicine |
SGUL Research Institute / Research Centre: |
Academic Structure > Institute of Medical & Biomedical Education (IMBE) |
Journal or Publication Title: |
Int Urogynecol J |
ISSN: |
1433-3023 |
Dates: |
Date | Event |
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November 2020 | Published | 16 June 2020 | Published Online | 28 May 2020 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
PubMed ID: |
32556846 |
Web of Science ID: |
WOS:000354619100016 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/112095 |
Publisher's version: |
https://doi.org/10.1007/s00192-020-04377-3 |
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