title: Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence.
abstract: OBJECTIVE
  Between 0.5 and 5% of vaginal deliveries involve obstetrical anal sphincter injuries (OASIS). Thirty to forty percent of patients with OASIS will suffer from anal incontinence in the subacute postpartum period. The aim of the present study was to assess the effectiveness of early pelvic floor muscle training (PFMT) combined with standard rehabilitation on anal incontinence after vaginal deliveries complicated by OASIS.
  
  
  METHODS
  The present work was a retrospective quantitative study performed in a tertiary-level maternity hospital. Women with 3rd or 4th degree obstetric tears were included. Women who gave birth between January 1st, 2011 and December 31st, 2012 underwent standard pelvic-perineal rehabilitation within 6-8 weeks postpartum. Women who gave birth between January 1st, 2013 and July 1st, 2014 had early rehabilitation (within 30 days after delivery) followed by the same standard rehabilitation received by the other group. Rehabilitation was performed by physiotherapists specialized in perineology. No electrostimulation was done in early rehabilitation. An in-house-validated modification of the Jorge and Wexner questionnaire was sent by mail to the patients to assess symptoms. The main judgment criterion was anal incontinence to gas, loose stools and/or solid stool.
  
  
  RESULTS
  Two hundred and thirty patients were diagnosed with OASIS. Nineteen women (8.3%) were lost to follow-up. The intention-to-treat analysis included 211 patients, 109 of whom underwent standard rehabilitation and 102 early rehabilitation plus standard rehabilitation. The two groups were comparable in terms of parity, birth weight, assisted delivery, epidural anesthesia and rates of mediolateral episiotomy. Multivariate analyses adjusted for type of perineal lesion were performed. Early rehabilitation significantly reduced gas leakage: OR 0.51 [0.29-0.90] (p=0.02), liquid stool leakage: OR 0.22 [0.08-0.58] (p=0.02) and urinary stress incontinence: OR 0.43 [0.24-0.77] (p=0.004).
  
  
  CONCLUSIONS
  We recommend early (during the first month postpartum) PFMT after vaginal deliveries associated with OASIS. Rehabilitation should be carried out by a physiotherapist specialized in perineology in order to prevent medium-term functional consequences. A longer follow-up may be necessary to confirm the stability of results.
authors.affiliation: Département de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Mélodie
authors.initials: M
authors.lastname: Mathé
authors.affiliation: Centre Tête d'Or, Lyon, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Valancogne
authors.affiliation: Département de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Atallah
authors.affiliation: Département de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Sciard
authors.affiliation: Département de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Doret
authors.affiliation: Département de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Gaucherand
authors.affiliation: Département de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France. Electronic address: etienne.beaufils@chu-lyon.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Beaufils
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005081:Exercise Therapy / Q000379:methods*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D017773:Pelvic Floor / Q000503:physiopathology*; D010502:Perineum / Q000293:injuries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anal incontinence; Jorge and Wexner score; OASIS; Pelvic floor muscle training (PFMT)