title: Outcome of repair of obstetric anal sphincter injuries after three years.
abstract: OBJECTIVE
  To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3 years after primary repair of obstetric anal sphincter injuries (OASIS).
  
  
  METHODS
  Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9 weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again.
  
  
  RESULTS
  Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P<0.001) and flatus incontinence (P<0.001) from 9 weeks to 3 years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3 years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3 years were fecal urgency at 9 weeks (OR 4.65; 95% CI, 1.38-15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09-1.80).
  
  
  CONCLUSIONS
  Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair.
authors.affiliation: Department of Obstetrics and Gynecology, Croydon University Hospital, Croydon, UK.
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Reid
authors.affiliation: Colorectal Research Fellow, Croydon University Hospital, Croydon, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Beggs
authors.affiliation: Department of Obstetrics and Gynecology, Croydon University Hospital, Croydon, UK. Electronic address: abdul.sultan@croydonhealth.nhs.uk.
authors.forename: Abdul H
authors.initials: AH
authors.lastname: Sultan
authors.affiliation: Department of Obstetrics and Gynecology, Croydon University Hospital, Croydon, UK.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Roos
authors.affiliation: Department of Obstetrics and Gynecology, Croydon University Hospital, Croydon, UK.
authors.forename: Ranee
authors.initials: R
authors.lastname: Thakar
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bowel symptoms; Childbirth; Endoanal scan; Fecal incontinence; Obstetric anal sphincter injuries; Third-degree tears; Vaginal delivery
references.citation: Gut. 1999 Jan;44(1):77-80
references.pmid: 9862829
references.citation: Best Pract Res Clin Obstet Gynaecol. 2004 Feb;18(1):157-73
references.pmid: 15123064
references.citation: Acta Obstet Gynecol Scand. 2003 Oct;82(10):921-8
references.pmid: 12956842
references.citation: BJOG. 2001 Oct;108(10):1057-67
references.pmid: 11702838
references.citation: Eur J Obstet Gynecol Reprod Biol. 2003 Aug 15;109(2):149-52
references.pmid: 12860332
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2009 Sep;20(9):1095-101
references.pmid: 19475329
references.citation: Acta Obstet Gynecol Scand. 2001 Sep;80(9):830-4
references.pmid: 11531634
references.citation: BJOG. 2005 Mar;112(3):312-6
references.pmid: 15713145
references.citation: Colorectal Dis. 2008 Feb;10(2):118-23
references.pmid: 18199292
references.citation: Am J Obstet Gynecol. 2005 Aug;193(2):530-4; discussion 534-6
references.pmid: 16098885
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2009 Aug;20(8):973-8
references.pmid: 19415154
references.citation: Aust N Z J Obstet Gynaecol. 2000 Aug;40(3):244-8
references.pmid: 11065029
references.citation: Ultrasound Obstet Gynecol. 2010 Sep;36(3):368-74
references.pmid: 20069661
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2009 Apr;20(4):407-10
references.pmid: 19082774
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2009 Sep;20(9):1029-35
references.pmid: 19458890
references.citation: Br J Obstet Gynaecol. 1996 Oct;103(10):1034-40
references.pmid: 8863705
references.citation: Am J Obstet Gynecol. 2007 Mar;196(3):217.e1-5
references.pmid: 17346526