title: The social, psychological, emotional morbidity and adjustment techniques for women with anal incontinence following Obstetric Anal Sphincter Injury: use of a word picture to identify a hidden syndrome.
abstract: BACKGROUND
  To identify the emotional, social and psychological consequences and recovery process of anal incontinence (AI) following obstetric anal sphincter injuries (OASIS) and explore if this can be identified as a recognisable syndrome with visual representation.
  
  
  METHODS
  A qualitative approach was adopted for this study. Data derived from case studies (n = 81) and interviews (n = 14) with women with AI after OASIS was used to identify the emotional, social and psychological consequences of AI after OASIS. Keywords and synonyms were extracted and the power of these statements displayed as a 'word picture'. The validity and authenticity of the word picture was then assessed by: a questionnaire sent to a group of mothers who had experienced this condition (n = 16); a focus group attended by mothers (n = 14) and supported by health professionals (n = 6) and via interviews with health professionals (n = 12) who were involved with helping mothers with AI following OASIS.
  
  
  RESULTS
  Women with AI resulting from OASIS have a specific syndrome - the 'OASIS Syndrome' - which we have uniquely visualised as a 'word picture'. They feel unclean which results in dignity loss, psychosexual morbidity, isolation, embarrassment, guilt, fear, grief, feeling low, anxiety, loss of confidence, a feeling of having been mutilated and a compromised role as a mother. Coping relies on repetitive washing (which may become a ritual), planning daily activities around toiletry needs, sharing, family support, employment if possible and attention to the baby. Recovery and healing is through care of the child and hope generated by love within the family.
  
  
  CONCLUSIONS
  This study has identified a previously unrecognised 'OASIS Syndrome' and, by way of a new and unique 'word picture', revealed a hidden condition. There should be greater awareness by the public and profession about the 'OASIS Syndrome' and a mechanism for early identification of the condition and referral for management. This, if successful, would overcome the barrier of silence which surrounds this currently unspoken taboo.
authors.affiliation: Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: M R B
authors.initials: MR
authors.lastname: Keighley
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Perston
authors.affiliation: St Marks Hospital London, Harrow, Middlesex, UK.
authors.forename: Elissa
authors.initials: E
authors.lastname: Bradshaw
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Hayes
authors.affiliation: Retired GP, Leeds, UK.
authors.forename: D Margaret
authors.initials: DM
authors.lastname: Keighley
authors.affiliation: Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. sara.webb@bwnft.nhs.uk.|Delivery Suite, Birmingham Women's NHS Foundation Trust, Mindlesohn Road, Edgbaston, Birmingham, B15 2TG, UK. sara.webb@bwnft.nhs.uk.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0002-4924-3017
authors.initials: S
authors.lastname: Webb
keywords: Anal incontinence; Morbidity; OASIS; Obstetric anal sphincter injury; Psychological trauma