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01-07-2005 | Original Contribution

Frequency of Persistent Anal Symptoms After First Instrumental Delivery

Authors: Chafika Mazouni, M.D., Florence Bretelle, M.D., Samy Battar, M.D., Pascal Bonnier, M.D., Marc Gamerre, M.D.

Published in: Diseases of the Colon & Rectum | Issue 7/2005

PURPOSE

This study was designed to evaluate persistent anal symptoms after first instrumental delivery beyond the postpartum period.

METHODS

This prospective study was performed in a cohort of primiparas who underwent instrumental delivery from January 1, 2001 to September 30, 2002. Questionnaires for anal symptoms were completed in the maternity ward on the day after delivery and by mail or telephone up to 12 months after the end of the inclusion period. Symptoms of fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatus incontinence, soiling, and/or fecal urgency) were recorded.

RESULTS

Of the 212 females who completed the first questionnaire, 159 (75 percent) responded to the second. Overall, 8.8 percent of females had solid and/or liquid stool incontinence, 7.5 percent had involuntary flatus, 8.2 percent had symptoms of fecal urgency, and 24.5 percent experienced new anal symptoms, Of the five females with third-degree tears, none complained of anal incontinence. The only significant difference in delivery data between females who did and did not develop new anal symptoms was larger fetal head size in the new symptom group (96.4 vs. 93.9 mm, respectively; P < 0.05).

CONCLUSIONS

Frequency of new anal symptoms other than incontinence beyond postpartum period is underestimated in primiparas after instrumental delivery. Only fetal head size was found to predict occurrence of persistent anal incompetence after instrumental delivery.

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Faltin, DL, Sangalli, MR, Roche, B, Floris, L, Boulvain, M, Weil, A 2001Does a second vaginal delivery increase the risk of anal incontinence?Br J Obstet Gynaecol1086848

Donnelly, V, Fynes, M, Campbell, D, Johnson, H, O’Connell, PR, O’Herlihy, C 1998Obstetric events leading to anal sphincter damageObstet Gynecol9295562PubMed

O’Boyle, AL, O’Boyle, JD, Ricks, RE, Patience, TH, Calhoun, B, Davis, G 2003The natural history of pelvic organ support in pregnancyInt Urogynecol J Pelvic Floor Dysfunct14469PubMed

Lunniss, PJ, Gladman, MA, Hetzer, FH, Williams, NS, Scott, SM 2004Risk factors in acquired faecal incontinenceJ R Soc Med971116PubMed

Fenner, DE, Genberg, B, Brahma, P, Marek, L, DeLancey, JO 2003Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United StatesAm J Obstet Gynecol18915439PubMed

Chiarelli, P, Murphy, B, Cockburn, J 2003Fecal incontinence after high-risk deliveryObstet Gynecol1021299305PubMed

Hall, W, McCracken, K, Osterweil, P, Guise, JM 2003Frequency and predictors for postpartum fecal incontinenceAm J Obstet Gynecol18812057PubMed

Sultan, AH, Johanson, RB, Carter, JE 1998Occult anal sphincter trauma following randomized forceps and vacuum deliveryInt J Gynaecol Obstet611139PubMed

Zetterström, JP, Lopez, A, Anzen, B, Dolk, A, Norman, M, Mellgren, A 1999Anal incontinence after vaginal delivery: a prospective study in primiparous womenBr J Obstet Gynaecol10632430PubMed

10.

Chaliha, C, Sultan, AH, Bland, JM, Monga, AK, Stanton, SL 2001Anal function: effect of pregnancy and deliveryAm J Obstet Gynecol18542732PubMed

11.

Walter, S, Hallbook, O, Gotthard, R, Bergmark, M, Sjodahl, R 2002A population-based study on bowel habits in a Swedish community: prevalence of faecal incontinence and constipationScand J Gastroenterol379116PubMed

12.

Kamm, MA 1994Obstetric damage and faecal incontinenceLancet3447303PubMed

13.

MacArthur, C, Bick, DE, Keighley, MR 1997Faecal incontinence after childbirthBr J Obstet Gynaecol1044650PubMed

14.

Cornes, H, Bartolo, DC, Stirrat, GM 1991Changes in anal canal sensation after childbirthBr J Surg78747PubMed

15.

Nazir, M, Carlsen, E, Nesheim, BI 2002Do occult anal sphincter injuries, vector volume manometry and delivery variables have any predictive value for bowel symptoms after first time vaginal delivery without third and fourth degree rupture? A prospective studyActa Obstet Gynecol Scand817206PubMed

16.

Schraffordt Koops, SE, Vervest, HA, Oostvogel, HJ 2003Anorectal symptoms after various modes of vaginal deliveryInt Urogynecol J Pelvic Floor Dysfunct142449PubMed

17.

Haadem, K, Ohrlander, S, Lingman, G 1988Long-term ailments due to anal sphincter rupture caused by delivery–a hidden problemEur J Obstet Gynecol Reprod Biol272732PubMed

18.

Hojberg, KE, Hundborg, HH, Ryhammer, AM, Laurberg, S 2003The impact of delivery on anorectal function in women with and women without anal incontinence–a prospective studyInt Urogynecol J Pelvic Floor Dysfunct143845PubMed

19.

Frudinger, A, Halligan, S, Bartram, CI, Spencer, J, Kamm, MA, Winter, R 2003Assessment of the predictive value of a bowel symptom questionnaire in identifying perianal and anal sphincter trauma after vaginal deliveryDis Colon Rectum467427PubMed

20.

Sultan, AH, Kamm, MA, Hudson, CN, Thomas, JM, Bartram, CI 1993Anal-sphincter disruption during vaginal deliveryN Engl J Med329190511PubMed

21.

Oberwalder, M, Dinnewitzer, A, Baig, MK, et al. 2004The association between late-onset fecal incontinence and obstetric anal sphincter defectsArch Surg13942932PubMed

22.

Fitzpatrick, M, O’Brien, C, O’Connell, PR, O’Herlihy, C 2003Patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinenceAm J Obstet Gynecol1897305PubMed

23.

Abramowitz, L, Sobhani, I, Ganansia, R, et al. 2000Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective studyDis Colon Rectum435906PubMed

24.

Fynes, M, Donnelly, V, Behan, M, O’Connell, PR, O’Herlihy, C 1999Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective studyLancet3549836PubMed

25.

Parades, V, Etienney, I, Thabut, D, et al. 2004Anal sphincter injury after forceps delivery: myth or reality? A prospective ultrasound study of 93 femalesDis Colon Rectum472434PubMed

26.

Groutz, A, Fait, G, Lessing, JB, et al. 1999Incidence and obstetric risk factors of postpartum anal incontinenceScand J Gastroenterol343158PubMed

Title: Frequency of Persistent Anal Symptoms After First Instrumental Delivery
Authors: Chafika Mazouni, M.D.
Florence Bretelle, M.D.
Samy Battar, M.D.
Pascal Bonnier, M.D.
Marc Gamerre, M.D.
Publication date: 01-07-2005
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 7/2005
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-005-0050-8

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Frequency of Persistent Anal Symptoms After First Instrumental Delivery

PURPOSE

METHODS

RESULTS

CONCLUSIONS

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

PURPOSE

METHODS

RESULTS

CONCLUSIONS

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