Anal incontinence in women with recurrent obstetric anal sphincter rupture: a case control study

Abstract

Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR.

Methods: Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St. Mark`s score), and the results were compared with those obtained in two control groups: women with subsequent uncomplicated vaginal delivery or caesarean section.

Results: There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3).

Conclusion: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies are required to confirm our findings.

• Anal incontinence
• anal sphincter
• subsequent delivery

Acknowledgements

We thank Mr. Sten Ladelund for his contribution to the statisticial analysis and Dr Edwin Stanton Spencer for English proofreading.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

RAB conducted the study, performed the analysis and was in-charge of the writing of the article. CN and NJS contributed to the study design, helped with statistical methods and helped to interpret the results as well as supervise the study. All authors assisted in critical revision of the manuscript and have read and approved the final version of the article.

Details of ethics approval

The study was approved by The Danish Data Protection Agency, and was carried out in compliance with the Helsinki Guidelines for Ethical Research. The National Committee on Health Research Ethics defined our project as a questionnaire based study, and not a health research project. Questionnaire based studies can be commenced without receiving permission from the Scientific Ethics Committees in the Capital Region of Denmark.