Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Long-term anal incontinence after obstetric anal sphincter injury-does grade of tear matter?

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Medical education research in obstetrics and gynecology

    Research output: Contribution to journalJournal articleResearch

  2. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: consensus report

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Multivitamin use and adverse birth outcomes in high-income countries: a systematic review and meta-analysis

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Sonographic prediction of outcome of vacuum deliveries: a multicenter, prospective cohort study

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Intravenous iron isomaltoside treatment of women suffering from severe fatigue after postpartum hemorrhage

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. The increasing role of a retained placenta in postpartum blood loss: a cohort study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Decline in severe spastic cerebral palsy at term in Denmark 1999-2007

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. The Danish Medical Birth Register

    Research output: Contribution to journalReviewResearchpeer-review

View graph of relations

BACKGROUND: Anal incontinence is a major concern following delivery with obstetric anal sphincter injury (OASIS), and has been related to the degree of sphincter tear.

OBJECTIVE: The aims of this study were (1) to evaluate whether women with a fourth-degree OASIS in the first delivery have an increased risk of long-term anal and fecal incontinence after a second delivery, and (2) to assess the impact of mode of second delivery on anal incontinence and related symptoms in these patients.

MATERIALS AND METHODS: We performed secondary analyses of a national questionnaire study in all Danish women with an OASIS in their first delivery and 1 subsequent delivery, both deliveries in 1997 to 2005. The questionnaires were sent a minimum of 5 years since the second delivery. In Denmark, women with anal incontinence after a delivery with OASIS are recommended elective cesarean deliveries in subsequent pregnancies. We performed uni- and multivariable logistic regression analyses to evaluate the outcomes.

RESULTS: In total, 2008 patients had an OASIS, of whom 12.2% (n = 245) had a fourth-degree tear in the first delivery. The median follow-up time since the first delivery with OASIS was 11.6 years (IQR, 10.2-13.2 years) and since the second delivery 8.5 years (IQR, 7.1-10.1 years). Women with a fourth-degree sphincter injury in the first delivery were at higher risk for anal incontinence (58.8%, n = 144) as well as fecal incontinence (30.6%, n = 75) than patients with a third-degree injury in the first delivery (41.0%, n = 723, and 14.6%, n = 258, respectively). The differences between groups persisted after adjustment for important maternal, fetal, and obstetric characteristics (adjusted odds ratio [aOR], 2.14; 95% confidence interval [CI], 1.52-3.02; P < 0.001 for anal incontinence; and aOR, 2.49; 95% CI, 1.73-3.56; P < 0.001 for fecal incontinence). In subgroup analyses of patients with fourth-degree anal sphincter injury in the first delivery, the mode of second delivery was not associated with the risk of anal incontinence (aOR, 0.97; 95% CI, 0.41-1.84; P = 0.71) or fecal incontinence (aOR, 1.28; 95% CI, 0.65-2.52; P = 0.48). The effect of the mode of the second delivery did not differ between women with a fourth-degree OASIS and those with a third-degree injury with regard to both anal (P = 0.09) and fecal (P = 0.96) incontinence.

CONCLUSION: After a second delivery, women with a fourth-degree OASIS in the first delivery have a higher risk of long-term anal and fecal incontinence than women with a third-degree sphincter injury. Adjusted odds of long-term anal and fecal incontinence did not differ significantly by mode of second delivery. Women with a fourth-degree OASIS should be informed about the increased risk of long-term anal incontinence and advised that subsequent elective cesarean delivery is not protective.

Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Volume218
Issue number2
Pages (from-to)232.E1- 232.E10
ISSN0002-9378
DOIs
Publication statusPublished - 2018

    Research areas

  • Journal Article

ID: 52396629