title: Obstetric anal sphincter injury: a follow-up questionnaire study on longer-term outcomes.
abstract: OBJECTIVE
  Obstetric anal sphincter injuries (OASIS) contribute significantly to the development of anal incontinence (AI) in women. The aim of this study was to establish the incidence of AI after OASIS and to study the influence on the quality of life (QoL) in patients with OASIS.
  
  
  METHODS
  This cohort study, with prospective case-control follow-up, involves women who were treated for OASIS between 2005 and 2012 in two academic medical centers in The Netherlands. Three hundred and thirteen patients and 780 controls were invited to complete a validated questionnaire (Defecation Distress Inventory, Wexner Incontinence Score, and Fecal Instrument Quality of Life) regarding symptoms and bother of AI subsequent and QoL after delivery. The main outcome measures were the presence of AI and the impact on QoL.
  
  
  RESULTS
  The questionnaire was completed by 141 patients and 194 controls. Mean follow-up was 4 years (range 1-9 years) in both groups. In the patient group, 55 women (39 %) reported AI symptoms compared with 38 women (20 %) in the control group (odds ratio 2.7, 95 % confidence interval 1.66-4.47, p < 0.01). In women who experienced symptoms of AI as very bothersome, QoL was affected in 14 (82.0 %) patients and three (33.5 %) controls (p = 0.012).
  
  
  CONCLUSIONS
  In this study, women with OASIS had a more than doubled risk of longer-term bothersome symptoms of AI compared with controls. Symptoms were experienced as bothersome and as having an influence on QoL.
authors.affiliation: Department of Obstetrics and Gynaecology, Medical University Centre Maastricht, Maastricht, The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Cornelisse
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: Linda Petra
authors.initials: LP
authors.lastname: Arendsen
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Sander Martijn Job
authors.initials: SM
authors.lastname: van Kuijk
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Kirsten Birgit
authors.initials: KB
authors.lastname: Kluivers
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.affiliation: Department of Obstetrics and Gynaecology, Zuyderland ziekenhuis, Heerlen, The Netherlands. m.weemhoff@zuyderland.nl.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Weemhoff
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007744:Obstetric Labor Complications; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Anal incontinence; Follow-up; Obstetric anal sphincter injury; Quality of life