title: Complete rupture of anal sphincter in primiparas: long-term effects and subsequent delivery.
abstract: OBJECTIVE
  To study long-term effects with respect to anal incontinence, pain, attitude to and mode of second delivery following complete rupture of the anal sphincter.
  
  
  METHODS
  Case-control study. Settings. Södersjukhuset, a university hospital in Stockholm.
  
  
  METHODS
  A case group of 136 primiparas who had experienced a complete rupture of the anal sphincter. Two matched control groups of primiparas, one of whom had cesarean section and the other a normal vaginal delivery.
  
  
  METHODS
  The case women were examined and asked for symptoms of anal incontinence 3-6 months after delivery; 3-8 years later they and two matched control groups answered a postal questionnaire. Response rate was 89%.
  
  
  METHODS
  Symptoms of pelvic floor dysfunction and, as secondary end-point, the attitude to and mode of second delivery.
  
  
  RESULTS
  Anal incontinence after delivery was reported by 31% in the case group, and at long-term follow-up by 54% in the case group, 21% in the cesarean section and 23% in the normal delivery group (p < 0.0001). A wish to postpone or abandon further childbirth was significantly more common in the case women (33 and 18%) than in the other groups, but about 60% delivered again in all groups. In the case group, the next delivery was by cesarean section in 49%.
  
  
  CONCLUSIONS
  At long-term follow-up after a complete rupture of the anal sphincter, anal incontinence was common and many women wished to postpone or avoid further delivery.
authors.affiliation: Södersjukhuset, Division of Obstetrics and Gynecology, Stockholm, Sweden. gisela.wegnelius@sodersjukhuset.se
authors.forename: Gisela
authors.initials: G
authors.lastname: Wegnelius
authors.forename: Margareta
authors.initials: M
authors.lastname: Hammarström
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries* / Q000294:innervation; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D020073:Gravidity; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000523:psychology; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology; D013548:Sweden; D013997:Time Factors; D016387:Women's Health; D055815:Young Adult