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The relationship between residual sphincter damage after primary repair, faecal incontinence, and anal sphincter function in primiparous women with an obstetric anal sphincter injury.
Neurourol Urodyn. 2019 01; 38(1):193-199.NU

Abstract

BACKGROUND AND AIMS

Anal sphincter injury has been identified as a primary cause of post-partum fecal incontinence in women with obstetric anal sphincter injury. However, women without obstetric anal sphincter injury may also develop fecal incontinence. The aim is to determine the relationship between fecal incontinence severity; and i) residual anal sphincter injury, quantified by the Starck score, and ii) anal sphincter tone.

METHODS

Consecutive case series of prospectively collected data set in a Pelvic Floor Unit within a tertiary teaching hospital in Australia. Population 181 primiparous women with Sultan classification Grade 3 and 4 sphincter injuries.

MAIN OUTCOME MEASURES

Sultan classification, anal manometry, pudendal nerve terminal motor latency, St Mark's fecal incontinence score, and Starck ultrasound score.

RESULTS

45% of women reported some degree of fecal incontinence. One third of women with normal external sphincter tone were incontinent. Those with higher Starck score had higher St Mark's scores. A higher Sultan classification correlated with more severe incontinence regardless if the repair was complete. Forceps delivery had a twofold risk of incontinence when compared to non-forceps delivery.

CONCLUSION

The importance of an effective anal sphincter repair is confirmed. However, overall there is no direct relationship between residual sphincter damage, anal sphincter tone, and fecal incontinence severity. These data indicate that anal sphincter integrity alone is not the sole mechanism for maintaining fecal continence. Rectal and colonic motor function may also play a role and investigation into these components may provide greater insight into the effect of vaginal delivery upon fecal continence mechanisms.

Authors+Show Affiliations

Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.Nepean Hospital Sydney, Department of Women and Children's Health, Sydney, New South Wales, Australia.Department of Women and Children's Health St George Public Hospital, University of NSW St George Clinical School, Kogarah, New South Wales, Australia.Department of Women and Children's Health St George Public Hospital, University of NSW St George Clinical School, Kogarah, New South Wales, Australia.College of Medicine and Public Health and Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia. Department of Surgery and Gastroenterology, Flinders Medical Centre, Bedford Park, South Australia, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30387531

Citation

Patton, Vicki, et al. "The Relationship Between Residual Sphincter Damage After Primary Repair, Faecal Incontinence, and Anal Sphincter Function in Primiparous Women With an Obstetric Anal Sphincter Injury." Neurourology and Urodynamics, vol. 38, no. 1, 2019, pp. 193-199.
Patton V, Kumar S, Parkin K, et al. The relationship between residual sphincter damage after primary repair, faecal incontinence, and anal sphincter function in primiparous women with an obstetric anal sphincter injury. Neurourol Urodyn. 2019;38(1):193-199.
Patton, V., Kumar, S., Parkin, K., Karantanis, E., & Dinning, P. (2019). The relationship between residual sphincter damage after primary repair, faecal incontinence, and anal sphincter function in primiparous women with an obstetric anal sphincter injury. Neurourology and Urodynamics, 38(1), 193-199. https://doi.org/10.1002/nau.23826
Patton V, et al. The Relationship Between Residual Sphincter Damage After Primary Repair, Faecal Incontinence, and Anal Sphincter Function in Primiparous Women With an Obstetric Anal Sphincter Injury. Neurourol Urodyn. 2019;38(1):193-199. PubMed PMID: 30387531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relationship between residual sphincter damage after primary repair, faecal incontinence, and anal sphincter function in primiparous women with an obstetric anal sphincter injury. AU - Patton,Vicki, AU - Kumar,Swetha, AU - Parkin,Katrina, AU - Karantanis,Emmanuel, AU - Dinning,Phil, Y1 - 2018/11/02/ PY - 2018/06/19/received PY - 2018/08/31/accepted PY - 2018/11/6/pubmed PY - 2020/1/29/medline PY - 2018/11/3/entrez KW - anal sphincter KW - fecal incontinence KW - obstetric KW - ultrasound SP - 193 EP - 199 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 38 IS - 1 N2 - BACKGROUND AND AIMS: Anal sphincter injury has been identified as a primary cause of post-partum fecal incontinence in women with obstetric anal sphincter injury. However, women without obstetric anal sphincter injury may also develop fecal incontinence. The aim is to determine the relationship between fecal incontinence severity; and i) residual anal sphincter injury, quantified by the Starck score, and ii) anal sphincter tone. METHODS: Consecutive case series of prospectively collected data set in a Pelvic Floor Unit within a tertiary teaching hospital in Australia. Population 181 primiparous women with Sultan classification Grade 3 and 4 sphincter injuries. MAIN OUTCOME MEASURES: Sultan classification, anal manometry, pudendal nerve terminal motor latency, St Mark's fecal incontinence score, and Starck ultrasound score. RESULTS: 45% of women reported some degree of fecal incontinence. One third of women with normal external sphincter tone were incontinent. Those with higher Starck score had higher St Mark's scores. A higher Sultan classification correlated with more severe incontinence regardless if the repair was complete. Forceps delivery had a twofold risk of incontinence when compared to non-forceps delivery. CONCLUSION: The importance of an effective anal sphincter repair is confirmed. However, overall there is no direct relationship between residual sphincter damage, anal sphincter tone, and fecal incontinence severity. These data indicate that anal sphincter integrity alone is not the sole mechanism for maintaining fecal continence. Rectal and colonic motor function may also play a role and investigation into these components may provide greater insight into the effect of vaginal delivery upon fecal continence mechanisms. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/30387531/The_relationship_between_residual_sphincter_damage_after_primary_repair_faecal_incontinence_and_anal_sphincter_function_in_primiparous_women_with_an_obstetric_anal_sphincter_injury_ L2 - https://doi.org/10.1002/nau.23826 DB - PRIME DP - Unbound Medicine ER -