Symptoms after obstetric sphincter injuries have little effect on quality of life.
OBJECTIVE
To compare the prevalence of anal incontinence and dyspareunia in women with or without obstetric sphincter injury after standardizing the suture technique.


METHODS
Retrospective case-control study.


METHODS
Regional hospital, Sweden.


METHODS
305 women with an obstetric sphincter injury and 297 women with spontaneous vaginal delivery.


METHODS
In order to standardize and improve the repairing skills of sphincter injuries, collaboration between obstetricians and colorectal surgeons was begun in 2000. Inner and external sphincters were repaired in two layers with continuous monofilament polidioxane sutures. The participating women received a questionnaire with validated questions on anal incontinence, dyspareunia and quality of life. The follow-up time was 15 months to 8 years.


METHODS
Anal incontinence, dyspareunia and quality of life.


RESULTS
Of the sphincter group, 72% returned the questionnaire, as did 67% in the control group. Significantly more women in the sphincter group suffered from incontinence of flatus and loose stool compared to controls (p < 0.05). There was no significant difference of incontinence of solid stool, soiling, or fecal urgency between the groups. The quality of life questions showed no significant difference between the groups. In the sphincter group, there was significantly more superficial coital pain compared to controls (p= 0.02). Significantly more women with complete sphincter injury reported anal incontinence than women with a partial sphincter injury.


CONCLUSIONS
In spite of increased rate of anal incontinence and dyspareunia after anal sphincter rupture, there was no statistically significant reduction in the women's quality of life.
Department of Obstetrics and Gynecology, Sundsvall Hospital, Sundsvall, Sweden. anna.palm@lvn.se
Anna
A
Palm
Leif
L
Israelsson
Marie
M
Bolin
Ingela
I
Danielsson
D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004414:Dyspareunia / Q000453:epidemiology / Q000523:psychology*; D004841:Episiotomy / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000523:psychology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology