Outcome of repair of obstetric anal sphincter injuries after three years

OBJECTIVE: To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3years after primary repair of obstetric anal sphincter injuries (OASIS).

METHODS: Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again.

RESULTS: Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P<0.001) and flatus incontinence (P<0.001) from 9weeks to 3years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3years were fecal urgency at 9weeks (OR 4.65; 95% CI, 1.38-15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09-1.80).

CONCLUSION: Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair.