title: Anal incontinence in women with recurrent obstetric anal sphincter rupture: a case control study.
abstract: OBJECTIVE
  To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR.
  
  
  METHODS
  Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St. Mark`s score), and the results were compared with those obtained in two control groups: women with subsequent uncomplicated vaginal delivery or caesarean section.
  
  
  RESULTS
  There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3).
  
  
  CONCLUSIONS
  Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies are required to confirm our findings.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Copenhagen, Hvidovre Hospital , Copenhagen , Denmark and.
authors.forename: Reneè A
authors.initials: RA
authors.lastname: Bøgeskov
authors.forename: Carsten N A
authors.initials: CN
authors.lastname: Nickelsen
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Secher
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D016022:Case-Control Studies; D036861:Delivery, Obstetric; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016387:Women's Health
keywords: Anal incontinence; anal sphincter; subsequent delivery