Year 2019 / Volume 111 / Number 6
Original
Quality of life and 3D-EUS assessment for anal incontinence after childbirth

453-459

DOI: 10.17235/reed.2019.6040/2018

Patricia Tejedor, Ignacio Bodega-Quiroga, Javier Plaza, Mario Ortega López, Carlos Gutierrez, Damian García Olmo, Carlos Pastor,

Abstract
Background: the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth. Methods: a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS. Results: a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8). Conclusions: AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.
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References
1. Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Annals of surgery. 2008;247(2):224-37.
2. Aigmueller T, Bader W, Beilecke K, et al. Management of 3rd and 4th Degree Perineal Tears after Vaginal Birth. Geburtshilfe und Frauenheilkunde. 2015;75(2):137-44.
3. Gurol-Urganci I, Cromwell DA, Edozien LC, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG : an international journal of obstetrics and gynaecology. 2013;120(12):1516-25.
4. Solans-Domenech M, Sanchez E, Espuna-Pons M. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstetrics and gynecology. 2010;115(3):618-28.
5. Hatem M, Fraser W, Lepire E. Postpartum urinary and anal incontinence: a population-based study of quality of life of primiparous women in Quebec. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2005;27(7):682-8.
6. Macmillan AK, Merrie AE, Marshall RJ, et al. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Diseases of the colon and rectum. 2004;47(8):1341-9.
7. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Diseases of the colon and rectum. 1993;36(1):77-97.
8. Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Diseases of the colon and rectum. 2000;43(1):9-16; discussion -7.
9. Tjandra JJ, Dykes SL, Kumar RR, et al. Practice parameters for the treatment of fecal incontinence. Diseases of the colon and rectum. 2007;50(10):1497-507.
10. Gold DM, Bartram CI, Halligan S, et al. Three-dimensional endoanal sonography in assessing anal canal injury. The British journal of surgery. 1999;86(3):365-70.
11. Wisser J, Schar G, Kurmanavicius J, et al. Use of 3D ultrasound as a new approach to assess obstetrical trauma to the pelvic floor. Ultraschall in der Medizin (Stuttgart, Germany : 1980). 1999;20(1):15-8.
12. Williams AB, Bartram CI, Halligan S, et al. Anal sphincter damage after vaginal delivery using three-dimensional endosonography. Obstetrics and gynecology. 2001;97(5 Pt 1):770-5.
13. Sultan AH, Kamm MA, Hudson CN, et al. Anal-sphincter disruption during vaginal delivery. The New England journal of medicine. 1993;329(26):1905-11.
14. Starck M, Bohe M, Valentin L. The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2006;27(2):188-97.
15. Rothbarth J, Bemelman WA, Meijerink WJ, et al. What is the impact of fecal incontinence on quality of life? Diseases of the colon and rectum. 2001;44(1):67-71.
16. Sultan AH. Editorial: Obstetrical Perineal Injury and Anal Incontinence. AVMA Medical & Legal Journal. 1999;5(6):193-6.
17. Oberwalder M, Connor J, Wexner SD. Meta-analysis to determine the incidence of obstetric anal sphincter damage. The British journal of surgery. 2003;90(11):1333-7.
18. Faltin DL, Boulvain M, Floris LA, et al. Diagnosis of anal sphincter tears to prevent fecal incontinence: a randomized controlled trial. Obstetrics and gynecology. 2005;106(1):6-13.
19. Damon H, Bretones S, Henry L, et al. Long-term consequences of first vaginal delivery-induced anal sphincter defect. Diseases of the colon and rectum. 2005;48(9):1772-6.
20. 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 disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2014;16(10):O347-55.
21. Donnelly V, O'Connell PR, O'Herlihy C. The influence of oestrogen replacement on faecal incontinence in postmenopausal women. British journal of obstetrics and gynaecology. 1997;104(3):311-5.
22. Frudinger A, Ballon M, Taylor SA, et al. The natural history of clinically unrecognized anal sphincter tears over 10 years after first vaginal delivery. Obstetrics and gynecology. 2008;111(5):1058-64.
23. Boreham MK, Richter HE, Kenton KS, et al. Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life. American journal of obstetrics and gynecology. 2005;192(5):1637-42.
24. Handa VL, Zyczynski HM, Burgio KL, et al. The impact of fecal and urinary incontinence on quality of life 6 months after childbirth. American journal of obstetrics and gynecology. 2007;197(6):636.e1-6.
25. Lynch AC, Dobbs BR, Keating J, et al. The prevalence of faecal incontinence and constipation in a general New Zealand population; a postal survey. N Z Med J. 2001 Oct 26;114(1142):474-7.doi: 10.1097/DCR.0b013e31822dd0f0
26. Walsh KA, Grivell RM. Use of endoanal ultrasound for reducing the risk of complications related to anal sphincter injury after vaginal birth. The Cochrane database of systematic reviews. 2015(10):Cd010826. doi: 10.1002/14651858.
27. Harvey MA, Pierce M, Alter JE, et al. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2015;37(12):1131-48.
29. Bartlett L, Nowak M, Ho YH. Impact of fecal incontinence on quality of life. World journal of gastroenterology. 2009;15(26):3276-82.
30. Johannessen HH, Wibe A, Stordahl A, et al. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG : an international journal of obstetrics and gynaecology. 2017;124(4):686-94.
31. Oakley SH, Ghodsi VC, Crisp CC, et al. Impact of Pelvic Floor Physical Therapy on Quality of Life and Function After Obstetric Anal Sphincter Injury: A Randomized Controlled Trial. Female pelvic medicine & reconstructive surgery. 2016;22(4):205-13.
32. Pauls RN, Crisp CC, Novicki K, et al. Impact of physical therapy on quality of life and function after vaginal reconstructive surgery. Female pelvic medicine & reconstructive surgery. 2013;19(5):271-7.
33. Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. Journal of clinical epidemiology. 2003;56(5):395-407.
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Tejedor P, Bodega-Quiroga I, Plaza J, Ortega López M, Gutierrez C, García Olmo D, et all. Quality of life and 3D-EUS assessment for anal incontinence after childbirth. 6040/2018


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Publication history

Received: 11/11/2018

Accepted: 17/12/2018

Online First: 25/04/2019

Published: 07/06/2019

Article revision time: 33 days

Article Online First time: 165 days

Article editing time: 208 days


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