title: Long-term function and morphology of the anal sphincters and the pelvic floor after primary repair of obstetric anal sphincter injury.
abstract: OBJECTIVE
  More than 50% of women experience deteriorating continence over time following primary repair of obstetric anal sphincter injuries. The objectives of this study were to assess the function and morphology of the anal sphincters and pelvic floor in women with long-term faecal incontinence after sphincter repair (primary end-point) and to evaluate their correlation with severity of incontinence (secondary end-point).
  
  
  METHODS
  The participants in this prospective study were recruited from a cohort of all women who sustained third or fourth degree obstetric sphincter injury reconstruction (cases) from January 1976 to November 1991. The women who delivered immediately before and after each case, without sustaining obstetric damage, were included as controls. Cases and controls were stratified into three categories: (i) continent; (ii) minor incontinence; and (iii) severe incontinence. The function and morphology of the anal sphincters and pelvic floor were evaluated by MRI, three-dimensional endoanal ultrasonography and anorectal physiology tests.
  
  
  RESULTS
  Fifty-nine women (29 cases/30 controls; mean age 51/53 years; mean follow-up 23.7/24.1 years, respectively) were assessed. Morphologically, cases had a significantly shorter anterior external anal sphincter length compared with controls when evaluated by three-dimensional endoanal ultrasonography (8.6 vs 10.2 mm; P = 0.03). Functionally, cases with severe incontinence had a significantly shorter anterior sphincter length compared with cases with minor incontinence (7.7 vs 10.4 mm; P = 0.04). No correlation could be found between anal pressures and severity of incontinence in the case group.
  
  
  CONCLUSIONS
  Cases had a significantly shorter anterior external anal sphincter length. Functionally, anterior sphincter length correlated with increased severity of incontinence.
authors: Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
authors: M M
authors: MM
authors: Soerensen
authors: B G
authors: BG
authors: Pedersen
authors: G A
authors: GA
authors: Santoro
authors: S
authors: S
authors: Buntzen
authors: K
authors: K
authors: Bek
authors: S
authors: S
authors: Laurberg
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D019160:Endosonography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008365:Manometry; D008875:Middle Aged; D036801:Parturition; D017773:Pelvic Floor / Q000000981:diagnostic imaging; D011312:Pressure; D011446:Prospective Studies; D012007:Rectum / Q000503:physiopathology; D012720:Severity of Illness Index; D013997:Time Factors; D015599:Trauma Severity Indices
keywords: Anal sphincter repair; anorectal manometry; endoanal ultrasonography; faecal incontinence; obstetric anal sphincter injury; pelvic MRI