Residual defects after repair of obstetric anal sphincter injuries and pelvic floor muscle strength are related to anal incontinence symptoms.
OBJECTIVE
The aim was to analyze the correlation between residual anal sphincter (AS) defects and pelvic floor muscle (PFM) strength on anal incontinence (AI) in patients with a history of obstetric AS injuries (OASIS).


METHODS
From September 2012 to February 2015, an observational study was conducted on a cohort of females who underwent repair of OASIS intrapartum. The degree of OASIS was scored intrapartum according to Sultan's classification. Participants were assessed at 6 months postpartum. Incontinence symptoms were evaluated using Wexner's score and PFM strength using the Modified Oxford Scale (MOS). 3D-endoanal ultrasound was performed to classify AS defects according to Starck's system. Correlation between Sultan's and Starck's classifications was calculated using Cohen's kappa and Spearman's rho (Rs) test. The impact of residual AS defects and PFM strength on AI was analyzed using a multiple regression model.


RESULTS
A total of 95 women were included in the study. Good correlation (κ= 0.72) was found between Sultan's and Starck's classifications. Significant positive correlation was observed between Wexner's score and both Sultan's (p = 0.023, Rs=0.212) and Starck's (p < 0.001, Rs=0.777) scores. The extent of the residual AS defect was the most relevant factor correlating with AI symptoms. In patients with severe AS injuries, higher MOS values were associated with lower Wexner's score.


CONCLUSIONS
The degree of AS tear measured intrapartum was the most important factor related to AI after primary repair of OASIS. PFM strength was associated with lower incontinence symptoms in the postpartum period.
Pelvic Floor Unit, ICGON, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain. cros@clinic.ub.es.|Pelvic Floor Unit, ICGON, Hospital Clínic, Villarroel 370, 08036, Barcelona, Spain. cros@clinic.ub.es.
Cristina Ros
CR
Cerro
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
Eva Martínez
EM
Franco
Pelvic Floor Unit, Department of Surgery, Treviso Regional Hospital, Treviso, Italy.
Giulio Aniello
GA
Santoro
Pelvic Floor Unit, ICGON, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
Maria José
MJ
Palau
Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland.
Pawel
P
Wieczorek
Pelvic Floor Unit, ICGON, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.
Montserrat
M
Espuña-Pons
D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000145:classification / Q000209:etiology / Q000601:surgery*; D053580:Muscle Strength / Q000502:physiology*; D007744:Obstetric Labor Complications / Q000209:etiology; D017773:Pelvic Floor; D011247:Pregnancy; D012044:Regression Analysis; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
Anal incontinence; OASIS; Pelvic floor muscle