Obstetric anal sphincter injury and anal incontinence

Czech version

Authors: Dvořák J.; Mašata J.; Švabík K.; Martan A.
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze
Published in: Ceska Gynekol 2021; 86(2): 118-122
Category:
doi: https://doi.org/10.48095/cccg2021118

Overview

Objective: The aim of our study is to clarify the problems of OASI (obstetric anal sphincter injuries) and anal incontinence and prevention of this injury. Methods: Review of articles in peer reviewed journals with the usage of Google Scholar function and PubMed. Conclusion: OASI is a severe injury which is more commonly associated with assisted vaginal delivery. This injury cannot be fully prevented, but its incidence can be averted by the usage of selective mediolateral episiotomy, or by other precautionary moves in high risk patients. The treatment of anal incontinence after OASI requires a complex approach and thorough examination. At first delivery, OASI is not a stern indication for caesarean section in accordance with current state of knowledge.

Keywords:

OASI – sphincter injury – anal incontinence – assisted vaginal delivery – vacuum-extraction – forceps

Sources

1. Jangö H, Langhoff-Roos J, Rosthøj S et al. Wexner score and quality of life in women with obstetric anal sphincter injury. Int Urogynecol J 2019; 31(6): 1115–1121. doi: 10.1007/ s00192-019-04134-1.

2. Ghai V, Pergialiotis V, Jan H et al. Obstetric anal sphincter injury: a systematic review of information available on the internet. Int Urogynecol J 2019; 30(5): 713–723. doi: 10.1007/ s00192-018-3753-9.

3. Anglim B, Kelly L, Fitzpatrick M. Risk factors and outcome of repair of obstetric anal sphincter injuries as followed up in a dedicated perineal clinic. Int Urogynecol J 2019; 30(10): 1649–1655. doi: 10.1007/ s00192-019-03960-7.

4. Beale M, Petros P. Passive management of labour may predispose to anal sphincter injury. Int Urogynecol J 2020; 31(9): 1943–1947. doi: 10.1007/ s00192-019-04183-6.

5. Burns E, Price L, Carpenter J et al. Predictors of obstetric anal sphincter injury during waterbirth: a secondary analysis of a prospective observational study. Int Urogynecol J 2019; 31(3): 651–656. doi: 10.1007/ s00192-019-04167-6.

6. D’Souza JC, Monga A, Tincello DG. Risk factors for obstetric anal sphincter injuries at vaginal birth after caesarean: a retrospective cohort study. Int Urogynecol J 2019; 30(10): 1747–1753. doi: 10.1007/ s00192-019-03978-x.

7. D’Souza JC, Monga A, Tincello DG et al. Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study. Int Urogynecol J 2019; 31(3): 627–633. doi: 10.1007/ s00192-019-03983-0.

8. Lincová M, Neumannová H, Mikysková I et al. Porodní poranění análního sfinkteru – analýza vlastního souboru rodiček mezi lety 2015–2017. Ceska Gynekol 2019; 84(1): 18–22.

9. O’Leary BD, Nolan CE, Ciprike V. Single prior caesarean section and risk of anal sphincter injury. Int Urogynecol J 2019; 30(6): 959–964. doi: 10.1007/ s00192-018-3797-x.

10. Preston HL, Alfirevic Z, Fowler GE et al. Does water birth affect the risk of obstetric anal sphincter injury? Development of a prognostic model. Int Urogynecol J 2019; 30(6): 909–915. doi: 10.1007/ s00192-019-03879-z.

11. van Bavel J, Hukkelhoven CW, de Vries C et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry. Int Urogynecol J 2017; 29(3): 407–413. doi: 10.1007/ s00192-017-3422-4.

12. Everist R, Burrell M, Mallitt KA et al. Postpartum anal incontinence in women with and without obstetric anal sphincter injuries. Int Urogynecol J 2020; 31(11): 2269–2275. doi: 10.1007/ s00192-020-04267-8.

13. Bliss DZ, Gurvich OV, Patel S et al. Self-management of accidental bowel leakage and interest in a supportive m-Health app among women. Int Urogynecol J 2019; 31(6): 1133–1140. doi: 10.1007/ s00192-019-04192-5.

14. Cattani L, Gillor M, Dietz HP. Does flatus incontinence matter? Int Urogynecol J 2019; 30(10): 1673–1677. doi: 10.1007/ s00192-018-3835-8.

15. Johannessen HH, Stafne SN, Falk RS et al. Prevalence and predictors of double incontinence 1 year after first delivery. Int Urogynecol J 2018; 29(10): 1529–1535. doi: 10.1007/ s00192-018-3577-7.

16. Dieb AS, Shoab AY, Nabil H et al. Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. Int Urogynecol J 2019; 31(3): 613–619. doi: 10.1007/ s00192-019-03937-6.

17. Bates LJ, Melon J, Turner R et al. Prospective comparison of obstetric anal sphincter injury incidence between an Asian and Western hospital. Int Urogynecol J 2018; 30(3): 429–437. doi: 10.1007/ s00192-018-3649-8.

18. O’Leary BD, Ciprike V. Are women attending a midwifery-led birthing center at increased risk of anal sphincter injury? Int Urogynecol J 2020; 31(3): 583–589. doi: 10.1007/ s00192-019-04218-y.

19. Wang R, Muñoz A, Blomquist JL et al. Association of race with anal incontinence in parous women. Int Urogynecol J 2019; 31(3): 545–551. doi: 10.1007/ s00192-019-04144-z.

20. Kamisan Atan I, Lai SK, Langer S et al. The impact of variations in obstetric practice on maternal birth trauma. Int Urogynecol J 2019; 30(6): 917–923. doi: 10.1007/ s00192-019-03887-z.

21. van der Vlist M, Oom D, van Rosmalen J et al. Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries. Int Urogynecol J 2020; 31(11): 2353–2359. doi: 10.1007/ s00192- 020-04241-4.

22. Diko S, Guiahi M, Nacht A et al. Prevention and management of severe obstetric anal sphincter injuries (OASIs): a national survey of nurse-midwives. Int Urogynecol J 2019; 31(3): 591–604. doi: 10.1007/ s00192-019-03897-x.

23. Cattani L, Van Schoubroeck D, Housmans Set al. Exo-anal imaging of the anal sphincter: a comparison between introital and transperineal image acquisition. Int Urogynecol J 2020; 31(6): 1107–1113. doi: 10.1007/ s00192-019-04122-5.

24. Hubka P, Švabík K, Mašata J et al. Pilotní studie srovnávající snášenlivost transperineálního a endoanálního ultrazvukového vyšetření svěrače konečníku. Ceska Gynekol 2019; 84(2): 111–114.

25. Subramaniam N, Robledo KP, Dietz HP. Anal sphincter imaging: better done at rest or on pelvic floor muscle contraction? Int Urogynecol J 2019; 31(6): 1191–1196. doi: 10.1007/ s00192-019-04130-5.

26. Gray TG, Vickers H, Jha S et al. A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth. Int Urogynecol J 2018; 30(6): 869–879. doi: 10.1007/ s00192-018-3819-8.

27. Norderval S, Rydningen M, Falk R et al. Strong agreement between interview-obtained and self-administered Wexner and St. Mark’s scores using a single questionnaire. Int Urogynecol J 2019; 30(12): 2101–2108. doi: 10.1007/ s00192-019-03945-6.

28. Bach FL, Sairally BZ, Latthe P. Effect of oestrogen therapy on faecal incontinence in postmenopausal women: a systematic review. Int Urogynecol J 2020; 31(7): 1289–1297. doi: 10.1007/ s00192-020-04252-1.

29. Kissane LM, Martin KD, Meyer I et al. Effect of darifenacin on fecal incontinence in women with double incontinence. Int Urogynecol J 2020. doi: 10.1007/ s00192-020-04369-3. Online ahead of print.

30. Mathé M, Valancogne G, Atallah A et al. Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence. Eur J Obstet Gynecol Reprod Biol 2016; 199: 201–206. doi: 10.1016/ j.ejogrb.2016.01.025.

31. Serati M, Salvatore S, Rizk D. Episiotomy in modern clinical practice: friend or foe? Int Urogynecol J 2019; 30(5): 669–671. doi: 10.1007/ s00192-019-03912-1.

32. Karbanova J, Rusavy Z, Betincova L et al. Clinical evaluation of peripartum outcomes of mediolateral versus lateral episiotomy. Int J Gynaecol Obstet 2013; 124(1): 72–76. doi: 10.1016/ j.ijgo.2013.07.011.

33. Karbanova J, Rusavy Z, Betincova L et al. Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy. Int J Gynaecol Obstet 2014; 127(2): 152–156. doi: 10.1016/ j.ijgo.2014.05.025.

34. Rusavy Z, Karbanova J, Kalis V. Timing of episiotomy and outcome of a non-instrumental vaginal delivery. Acta Obstett Gynecol Scand 2015; 95(2): 190–196. doi: 10.1111/ aogs.12814.

35. Andrews V, Thakar R, Sultan AH et al. Are mediolateral episiotomies actually mediolateral? BJOG 2005; 112(8): 1156–1158. doi: 10.1111/ j.1471-0528.2005.00645.x.

36. Divakova O, Khunda A, Ballard PA. Episcissors-60™ and obstetrics anal sphincter injury: a systematic review and meta-analysis. Int Urogynecol J 2019; 31(3): 605–612. doi: 10.1007/ s00192-019-03901-4.

37. Koh LM, van Roon Y, Pradhan A et al. Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom. Int Urogynecol J 2020; 31(9): 1729–1734. doi: 10.1007/ s00192-019-04201-7.

38. Jansova M, Kalis V, Rusavy Z et al. Modeling manual perineal protection during vaginal delivery. Int Urogynecol J 2013; 25(1): 65–71. doi: 10.1007/ s00192-013-2164-1.

39. Laine K, Skjeldestad FE, Sandvik L et al. Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study. BMJ Open 2012; 2(5): e001649. doi: 10.1136/ bmjopen-2012-001649.

40. Urbankova I, Grohregin K, Hanacek J et al. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecol J 2019; 30(10): 1689–1696. doi: 10.1007/ s00192-019-04044-2.

41. Brito LG, Ferreira CH, Duarte G et al. Antepartum use of Epi-No birth trainer for preventing perineal trauma: systematic review. Int Urogynecol J 2015; 26(10): 1429–1436. doi: 10.1007/ s00192-015-2687-8.

42. Kamisan Atan I, Shek KL, Langer S et al. Does the Epi-No® birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG 2016; 123(6): 995–1003. doi: 10.1111/ 1471-0528.13924.

43. Evans E, Falivene C, Briffa K et al. What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study. Int Urogynecol J 2019; 31(3): 557–566. doi: 10.1007/ s00192-019-04108-3.

44. Jordan PA, Naidu M, Thakar R et al. Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury. Int Urogynecol J 2018; 29(11): 1579–1588. doi: 10.1007/ s00192-018-3601-y.

45. Webb SS, Sitch A, MacArthur C. The impact of mode of subsequent birth after obstetric anal sphincter injury on bowel function and related quality of life: a cohort study. Int Urogynecol J 2020; 31(11): 2237–2245. doi: 10.1007/ s00192-020-04234-3.

46. Abramowitz L, Mandelbrot L, Bourgeois Moine A et. al. Cesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetrical anal sphincter injury: the EPIC multicenter randomized trial. BJOG 2020; 128(4): 685–693. doi: 10.1111/ 1471-0528.16452.

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Article was published in

Czech Gynaecology

2021 Issue 2