title: Long-term outcome after obstetric injury: a retrospective study.
abstract: OBJECTIVE
  To examine problems experienced by women after vaginal delivery with and without a sphincter tear and compare those with less and more severe injuries.
  
  
  METHODS
  Retrospective questionnaire study. Setting. Regional hospital in Sweden.
  
  
  METHODS
  A total of 324 women with and 309 without sphincter tears.
  
  
  METHODS
  Questionnaires were sent out four to eight years after delivery enquiring about the existence and time course of gas incontinence, fecal incontinence, dyspareunia and perineal pain. A question about vacuum delivery was also included.
  
  
  METHODS
  Prevalence of persisting symptoms.
  
  
  RESULTS
  The reply rate was 77%. About 10% of the women with a sphincter tear had fecal incontinence initially, compared with 3% among those without a sphincter tear. In women with moderate or severe tears, 20 and 31%, respectively, had gas incontinence, compared with 6% of women without a tear. Dyspareunia and perineal pain were present 18-23% of women in the tear groups compared with 9-12% of those without a tear. Almost 45% of women with initial symptoms had remaining problems after four to eight years. There was a significantly higher risk for symptoms after vacuum extraction (p < 0.001).
  
  
  CONCLUSIONS
  Gas incontinence, fecal incontinence, dyspareunia and perineal pain were common problems after delivery. The prevalence of persisting symptoms was high even among women without a tear. The higher prevalence after vacuum extraction delivery indicates that there are more complications associated with this mode of delivery than previously thought.
authors.affiliation: Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden. janchrister.sundquist@ltdalarna.se
authors.forename: Jan-Christer
authors.initials: JC
authors.lastname: Sundquist
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004414:Dyspareunia / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005414:Flatulence / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015601:Injury Severity Score; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D010502:Perineum / Q000503:physiopathology; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects