5 years ago

Anal sphincter defects and faecal incontinence 15–24 years after first delivery: a cross-sectional study

Kjell Å Salvesen, Rodrigo A. Guzmán Rojas, Ingrid Volløyhaug
Objectives To establish the prevalence of external (EAS) and internal anal sphincter (IAS) defects 15–24 years after childbirth in association to mode of delivery and faecal incontinence (FI), and compare the proportion of obstetric anal sphincter injuries (OASIS) reported at delivery with defects on ultrasound. Methods This was a cross-sectional study including 563 women, who delivered their first child from 1990–97. Women responded to a validated questionnaire (PFDI) in 2013–14. The proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent 4D transperineal ultrasound examination. A defect of the EAS and IAS of ≥30° in ≥4/6 planes on tomographic ultrasound was registered. Multiple logistic regression was used to calculate adjusted odds ratios (aOR) for comparison of prevalence of EAS defects between different modes of delivery and in association to FI. Fisher's exact test was used for IAS defects. Results Defects of EAS and IAS were found after normal delivery (n = 201): 10% and 1%; forceps (n = 144): 32% and 7%; vacuum (n = 120): 15% and 4%, and no defects after caesarean section (n = 98). Forceps was associated with increased risk of EAS defects compared to normal delivery (aOR 4.1, 95% CI 2.3-7.2) and vacuum (aOR 3.0, 95% CI 1.6-5.6) and increased risk of IAS defects compared to normal delivery (cOR 7.4, 95% CI 1.5-70.5). The difference between vacuum and normal delivery was not significant. FI was indicated by 18% of women with EAS defects, 29% with IAS defects and 8% without sphincter defects. EAS and IAS defects were associated with increased risk of FI (aOR 2.5, 95% CI 1.3-4.9; cOR 4.2, 95% CI 1.1-13.5). 80% of ultrasonographical sphincter defects were not reported as OASIS at first or subsequent deliveries. Conclusions Anal sphincter defects visualized by transperineal ultrasound 15–24 years after delivery were associated with forceps and FI. Undetected OASIS was frequent.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18827

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