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Long-term function and morphology of the anal sphincters and the pelvic floor after primary repair of obstetric anal sphincter injury.
Colorectal Dis. 2014 Oct; 16(10):O347-55.CD

Abstract

AIM

More than 50% of women experience deteriorating continence over time following primary repair of obstetric anal sphincter injuries. The objectives of this study were to assess the function and morphology of the anal sphincters and pelvic floor in women with long-term faecal incontinence after sphincter repair (primary end-point) and to evaluate their correlation with severity of incontinence (secondary end-point).

METHOD

The participants in this prospective study were recruited from a cohort of all women who sustained third or fourth degree obstetric sphincter injury reconstruction (cases) from January 1976 to November 1991. The women who delivered immediately before and after each case, without sustaining obstetric damage, were included as controls. Cases and controls were stratified into three categories: (i) continent; (ii) minor incontinence; and (iii) severe incontinence. The function and morphology of the anal sphincters and pelvic floor were evaluated by MRI, three-dimensional endoanal ultrasonography and anorectal physiology tests.

RESULTS

Fifty-nine women (29 cases/30 controls; mean age 51/53 years; mean follow-up 23.7/24.1 years, respectively) were assessed. Morphologically, cases had a significantly shorter anterior external anal sphincter length compared with controls when evaluated by three-dimensional endoanal ultrasonography (8.6 vs 10.2 mm; P = 0.03). Functionally, cases with severe incontinence had a significantly shorter anterior sphincter length compared with cases with minor incontinence (7.7 vs 10.4 mm; P = 0.04). No correlation could be found between anal pressures and severity of incontinence in the case group.

CONCLUSIONS

Cases had a significantly shorter anterior external anal sphincter length. Functionally, anterior sphincter length correlated with increased severity of incontinence.

Authors+Show Affiliations

Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24502361

Citation

Soerensen, M M., et al. "Long-term Function and Morphology of the Anal Sphincters and the Pelvic Floor After Primary Repair of Obstetric Anal Sphincter Injury." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 16, no. 10, 2014, pp. O347-55.
Soerensen MM, Pedersen BG, Santoro GA, et al. Long-term function and morphology of the anal sphincters and the pelvic floor after primary repair of obstetric anal sphincter injury. Colorectal Dis. 2014;16(10):O347-55.
Soerensen, M. M., Pedersen, B. G., Santoro, G. A., Buntzen, S., Bek, K., & Laurberg, S. (2014). Long-term function and morphology of the anal sphincters and the pelvic floor after primary repair of obstetric anal sphincter injury. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 16(10), O347-55. https://doi.org/10.1111/codi.12579
Soerensen MM, et al. Long-term Function and Morphology of the Anal Sphincters and the Pelvic Floor After Primary Repair of Obstetric Anal Sphincter Injury. Colorectal Dis. 2014;16(10):O347-55. PubMed PMID: 24502361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term function and morphology of the anal sphincters and the pelvic floor after primary repair of obstetric anal sphincter injury. AU - Soerensen,M M, AU - Pedersen,B G, AU - Santoro,G A, AU - Buntzen,S, AU - Bek,K, AU - Laurberg,S, PY - 2013/06/03/received PY - 2013/10/29/accepted PY - 2014/2/8/entrez PY - 2014/2/8/pubmed PY - 2015/5/30/medline KW - Anal sphincter repair KW - anorectal manometry KW - endoanal ultrasonography KW - faecal incontinence KW - obstetric anal sphincter injury KW - pelvic MRI SP - O347 EP - 55 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 16 IS - 10 N2 - AIM: More than 50% of women experience deteriorating continence over time following primary repair of obstetric anal sphincter injuries. The objectives of this study were to assess the function and morphology of the anal sphincters and pelvic floor in women with long-term faecal incontinence after sphincter repair (primary end-point) and to evaluate their correlation with severity of incontinence (secondary end-point). METHOD: The participants in this prospective study were recruited from a cohort of all women who sustained third or fourth degree obstetric sphincter injury reconstruction (cases) from January 1976 to November 1991. The women who delivered immediately before and after each case, without sustaining obstetric damage, were included as controls. Cases and controls were stratified into three categories: (i) continent; (ii) minor incontinence; and (iii) severe incontinence. The function and morphology of the anal sphincters and pelvic floor were evaluated by MRI, three-dimensional endoanal ultrasonography and anorectal physiology tests. RESULTS: Fifty-nine women (29 cases/30 controls; mean age 51/53 years; mean follow-up 23.7/24.1 years, respectively) were assessed. Morphologically, cases had a significantly shorter anterior external anal sphincter length compared with controls when evaluated by three-dimensional endoanal ultrasonography (8.6 vs 10.2 mm; P = 0.03). Functionally, cases with severe incontinence had a significantly shorter anterior sphincter length compared with cases with minor incontinence (7.7 vs 10.4 mm; P = 0.04). No correlation could be found between anal pressures and severity of incontinence in the case group. CONCLUSIONS: Cases had a significantly shorter anterior external anal sphincter length. Functionally, anterior sphincter length correlated with increased severity of incontinence. SN - 1463-1318 UR - https://www.unboundmedicine.com/medline/citation/24502361/Long_term_function_and_morphology_of_the_anal_sphincters_and_the_pelvic_floor_after_primary_repair_of_obstetric_anal_sphincter_injury_ L2 - https://doi.org/10.1111/codi.12579 DB - PRIME DP - Unbound Medicine ER -