title: Complete obstetric anal sphincter tear and risk of long-term fecal incontinence: a cohort study.
abstract: BACKGROUND
  Women with anal sphincter injuries have an increased risk of developing fecal incontinence despite surgical intervention.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the long-term risk of fecal incontinence after primary anal sphincter reconstruction and its impact on quality of life.
  
  
  METHODS
  This was a cohort study.
  
  
  METHODS
  This study was performed at Aarhus University Hospital.
  
  
  METHODS
  Women with complete anal sphincter rupture (exposed) from 1976 to 1991 and a control group of parous women (nonexposed) were included.
  
  
  RESULTS
  The primary outcomes measured were fecal incontinence, Wexner score, St Mark incontinence score, and quality of life.
  
  
  RESULTS
  A total of 363 women were included (125 exposed and 238 nonexposed). The mean age was 50.4 years (95%CI: 49.8-51.0), with 22.2 years (95% CI: 21.7-22.6) of follow-up. At the time of follow-up, 49% of exposed women and 74% of nonexposed women were continent. Complete anal sphincter tear increases the risk of fecal incontinence twofold (relative risk = 2.00; 95%CI: 1.52-2.63). No other risk factors were identified. The mean Wexner score was 1.7 (95%CI: 1.3-2.1) vs 1.1 (95%CI: 0.7-1.4) (p = 0.02), and the mean St Mark score was 2.8 (95% CI: 2.1-3.4) vs 1.4 (95%CI: 1.0-1.9) (p < 0.001) in the exposed and nonexposed groups. Severity of fecal incontinence had a significant impact on the quality of life independent of exposure.
  
  
  CONCLUSIONS
  The cohort is relatively young; a short postmenopausal period limits the assessment of hormonal status and the effect of postmenopausal hormone replacement therapy.
  
  
  CONCLUSIONS
  Complete obstetric anal sphincter tear increases the long-term risk of fecal incontinence twofold. When present, the severity of the incontinence symptoms is minor and the risk of incontinence for solid stool is not increased in comparison with the general population. Anal sphincter rupture is the only independent risk factor for fecal incontinence. The severity of fecal incontinence had the same impact on quality of life in both groups.
authors.affiliation: Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark. soerensen_mette@hotmail.com
authors.forename: Mette M
authors.initials: MM
authors.lastname: Soerensen
authors.forename: Steen
authors.initials: S
authors.lastname: Buntzen
authors.forename: Karl M
authors.initials: KM
authors.lastname: Bek
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001004:Anus Diseases / Q000150:complications* / Q000503:physiopathology; D003672:Defecation; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture; D012720:Severity of Illness Index