title: Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading: an observational cohort study.
abstract: OBJECTIVE
  This study was conducted to investigate the long-term development of anal and urinary incontinence and to investigate the clinical value of electromyography and pudendal nerve terminal motor latency after obstetric anal sphincter rupture.
  
  
  METHODS
  One hundred females with obstetric anal sphincter rupture were evaluated by an anal incontinence questionnaire at 5 and 18 months postpartum and by a urine incontinence questionnaire at 18 months postpartum. Pudendal nerve terminal motor latency and electromyography examinations were performed on 68 and 67 females, respectively, at 10 months postpartum.
  
  
  RESULTS
  Fecal incontinence increased from 7 to 17 percent between 5 and 18 months (P = 0.04). At 18 months, the incidence of anal incontinence in females working outside the home (42/70 (60 percent)) was greater than that for females still at home with their child (12/30 (40 percent); P = 0.05). Anal incontinence at 18 months was significantly higher (P = 0.01) in subjects with pathologic electromyographic findings (76 percent) than in those with normal electromyography (45 percent; observed differences, 31 percent (95 percent confidence interval, 9 to 54 percent)). Thirty percent of the subjects had urinary stress incontinence. The risk of fecal urgency was greater in females with urinary urgency (difference, 44 percent; 95 percent confidence interval, 18 to 69 percent) and urinary stress incontinence (difference, 24 percent; 95 percent confidence interval, 3 to 44 percent) than in those without.
  
  
  CONCLUSIONS
  Fecal incontinence symptoms worsen with increased follow-up time, and the change in working status is the most likely explanation; therefore, early evaluation of bowel symptoms is misleading. Denervation injury of the anal sphincter is an independent risk factor for anal incontinence but has no association with urinary incontinence. Urinary urgency and stress incontinence symptoms are strongly associated with fecal urgency.
authors.affiliation: Department of Abdominal Surgery, Ulleval University Hospital, University of Oslo, Oslo, Norway.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Nazir
authors.forename: Ragnar
authors.initials: R
authors.lastname: Stien
authors.forename: Erik
authors.initials: E
authors.lastname: Carlsen
authors.forename: Anne Flem
authors.initials: AF
authors.lastname: Jacobsen
authors.forename: Britt-Ingjerd
authors.initials: BI
authors.lastname: Nesheim
mesh_terms: D001003:Anal Canal / Q000293:injuries* / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D004576:Electromyography; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D009046:Motor Neurons / Q000502:physiology; D009130:Muscle, Smooth / Q000503:physiopathology; D019370:Observation; D007744:Obstetric Labor Complications / Q000601:surgery*; D011247:Pregnancy; D012421:Rupture / Q000145:classification; D011795:Surveys and Questionnaires; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000209:etiology*; D014931:Women, Working / Q000706:statistics & numerical data