Top

International Urogynecology Journal

Published in:

01-01-2013 | Original Article

Anal and urinary incontinence 4 years after a vaginal delivery

Authors: Vasanth Andrews, Susan Shelmeridine, Abdul H. Sultan, Ranee Thakar

Published in: International Urogynecology Journal | Issue 1/2013

Abstract

Introduction and hypothesis

Our purpose was to establish the incidence of anal and urinary incontinence 4 years following vaginal delivery in women with and without obstetric anal sphincter injuries (OASIS).

Methods

This was a prospective study of 241 having their first vaginal delivery who had independent verification and repair of OASIS by trained obstetricians. All obstetricians performing OASIS repairs had undergone structured hands-on training and were then directly supervised while repairing OASIS until they were deemed competent to repair independently. Patients were followed up for 4 years with validated bowel and urinary questionnaires. In order to minimise nonresponders, contact details were verified and obtained from their general practitioners, the local primary care trust and electoral roll.

Results

Two hundred and fifty-four women were invited, and 241 (95 %) participated. Fifty-nine (25 %) women sustained OASIS. One hundred and forty-nine were contactable 4 years later, and 86 (58 %) agreed to participate in the study at 4 years. No woman had faecal incontinence, and there was no difference in rates of flatus incontinence prior to delivery up to 4 years postpartum, regardless of whether OASIS occurred or not. Urinary incontinence was more than four times more common after vaginal birth, and this was not affected by whether OASIS occurred and resulted in a significant deterioration in quality of life.

Conclusions

The previously reported higher rates of anal incontinence following OASIS can be minimised up to 4 years after delivery if repaired by trained doctors. There is a significant increase in urinary incontinence following vaginal delivery, and the mechanism for this is not linked to anal sphincter disruption.

Scheer I, Andrews V, Thakar R, Sultan AH (2008) Urinary incontinence after Obstetric Anal Sphincter Injuries (OASIS) - Is there a relationship? Int Urogynecol J Pelvic Floor Dysfunct 19:179–183PubMedCrossRef

Viktrup L (2002) The risk of lower urinary tract sypmptoms five years after the first delivery. Neurourol Urodyn 21(1):2–29PubMedCrossRef

Fernando R, Sultan AH, Radley S, Jones PW, Johanson RB (2002) Management of obstetric anal sphincter injury: a systematic review and national practice survey. BMC Health Serv Res 2:9PubMedCrossRef

Wagenius J, Laurin J (2003) Clinical symptoms after anal sphincter rupture: a retrospective study. Acta Obstet Gynecol Scand 82:246–250PubMedCrossRef

Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36PubMed

Hagglund D, Wadensten B (2007) Fear of humiliation inhibits women’s care-seeking behaviour for long-term urinary incontinence. Scand J Caring Sci 21:305–312PubMedCrossRef

Bugg GJ, Kiff ES, Hosker G (2001) A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. Br J Obstet Gynecol 108:1057–1067CrossRef

Avery K, Donovan JL, Abrams P (2001) Validation of a new questionnaire for incontinence: the international consultation on incontinence questionnaire (ICI-Q). Neurourol Urodyn 20:86

Royal College of Obstetricians and Gynaecologists (2007) Third- and fourth-degree perineal tears - management. RCOG Press, London, RCOG Guideline No. 29

10.

Andrews V, Thakar R, Sultan AH (2009) Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynaecol J 20:193–199CrossRef

11.

Thakar R, Sultan AH (2003) Management of obstetric anal sphincter injury. Obstet Gynaecol 5(2):72–78CrossRef

12.

Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries – myth or reality. Br J Obstet Gynecol 113:195–200CrossRef

13.

Sander P, Bjarnesen J, Mouritsen L, Fuglsang-Frederiksen A (1999) Anal incontinence after obstetric third-/fourth-degree laceration. One-year follow-up after pelvic floor exercises. Int Urogynecol J 10:177–181CrossRef

14.

Pinta TM, Kylanpaa ML, Salmi TK et al (2004) Sphincter rupture and anal incontinence after first delivery. Acta Obstet Gynecol Scand 83:917–922PubMed

15.

Fitzpatrick M, Cassidy M, O’Connell R, O’Herlihy C (2002) Experience with an obstetric perineal clinic. Eur Jour Obstet Gynecol Reprod Biol 100:199–203CrossRef

16.

Starck M, Bohe M, Valentin L (2006) The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol 27:188–197PubMedCrossRef

17.

Zetterstrom J, Lopez A, Anzen B, Norman M, Holmstrom B, Mellgren A (1999) Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol 94(1):21–28PubMedCrossRef

18.

Uustal Fornell EK, Berg G, Hallbook O, Matthiesen LS, Sjodahl R (1996) Clinical consequences of anal sphincter rupture during childbirth. J Am Coll Surg 183:553–558

19.

Nazir M, Stein R, Carlsen E et al (2003) Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture misleading. Dis Colon Rectum 46(9):1245–1250PubMedCrossRef

20.

Tetzschner T, Sorensen M, Ge L et al (1996) Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynecol 103:1034–1040CrossRef

21.

Otero M, Boulvain M, Bianchi-Demicheli F et al (2006) Women’s health 18 years after rupture of the anal sphincter during childbirth. Urinary incontinence, sexual function, and physical and mental health. Am J Obstet Gynecol 194(5):1260–1265PubMedCrossRef

22.

Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872PubMedCrossRef

23.

Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. New Eng J Med 329:1905–1911PubMedCrossRef

Title: Anal and urinary incontinence 4 years after a vaginal delivery
Authors: Vasanth Andrews
Susan Shelmeridine
Abdul H. Sultan
Ranee Thakar
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 1/2013
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1835-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anal and urinary incontinence 4 years after a vaginal delivery

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

A cross-sectional survey of the relationship between fecal incontinence and constipation

Evaluation of a therapeutic vaccine for the prevention of recurrent urinary tract infections versus prophylactic treatment with antibiotics

Traditional native tissue vs mesh-augmented pelvic organ prolapse repairs: providing an accurate interpretation of current literature. Comment

Comparative analysis of pelvic ligaments: a biomechanics study

Treatment of overactive bladder: what is on the horizon?

Cardinal and deep uterosacral ligament lines of action: MRI based 3D technique development and preliminary findings in normal women