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Anal Incontinence Linked to Vaginal Delivery With Laceration


 

FROM THE ANNUAL MEETING OF THE SOCIETY OF GYNECOLOGIC SURGEONS

BALTIMORE – Anal sphincter laceration is significantly associated with anal incontinence 5-10 years after a woman’s first delivery and has significant impact on quality of life, compared with women who had a vaginal delivery without laceration and women who had cesarean section.

The findings come from a secondary analysis of 1,007 women enrolled in a prospective cohort study of pelvic floor outcomes.

However, researchers noted that women who had vaginal delivery without tear had similar anal incontinence symptoms as those seen in women who had cesarean sections.

"This suggests that vaginal delivery – in the absence of sphincter laceration – is not a risk factor for anal incontinence," said Dr. Joan L. Blomquist, an obstetrician at Greater Baltimore Medical Center, who presented the study at the annual meeting of the Society for Gynecologic Surgeons.

Obstetrical anal sphincter laceration is a known risk factor for anal incontinence. In this study, the researchers compared anal incontinence and adverse impact on their quality of life between women who had a vaginal delivery with anal sphincter laceration, compared with woman who had a vaginal delivery without anal sphincter laceration and women who underwent a cesarean procedure.

They performed a secondary analysis of data from the Mothers’ Outcomes After Delivery (MOAD) prospective cohort study of pelvic floor outcomes. For this analysis, the researchers included women whose first delivery was 5-10 years previous. Sphincter laceration was defined as a clinically recognizable third or fourth degree laceration.

Anal incontinence symptoms were assessed using the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ). The researchers used the published threshold of 22.8 to identify anal incontinence. The impact on quality of life was assessed using the Colorectal-Anal Impact Questionnaire (CRAIQ-7).

Nineteen percent of women who had vaginal delivery and anal sphincter laceration met the criteria for anal incontinence according to the EPIQ. In comparison, among women with vaginal delivery without tear or women who underwent cesarean delivery, only 10% and 9% met the criteria.

They identified 1,007 women – 95 with vaginal delivery with a tear, 353 with vaginal delivery without a tear, and 559 with cesarean delivery. The groups did not differ with regard to race, age at enrollment or age greater than 35 at the first delivery. There were a slightly greater number of multiparous women in the vaginal control group. Women in the cesarean group were more likely to be obese at the time of enrollment.

In terms of bowel symptoms, the researchers asked if the women ever lost gas, liquid stool, or loose well-formed stool beyond their control. There was very little difference between the vaginal delivery without tear group and the cesarean delivery group for all three questions. However, there was a significant difference between cesarean delivery and vaginal delivery with tear.

The researchers also asked women with any bowel symptoms if their symptoms had affected their chores, physical recreation, entertainment, travel, social activities, and feeling frustrated. Again, the numbers were similar for vaginal delivery without tear and cesarean delivery. Women with tears had significantly greater impact on all of the activities.

All of the researchers reported that they have no relevant conflicts of interest to disclose. The study was supported by a National Institutes of Health grant.

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