RESULTS
A total of 82 women had surgical repair of major OASIS. Of these, 73
women (89%) returned the questionnaire at a mean 26 months post
sphincter repair and these women formed Group A. Groups B and C
consisted of 55 and 83 patients respectively recruited during the same
period. Patient characteristics are presented in Table 1. Of note,
patients in Group C were significantly younger than those in Groups A
and B. The overall prevalence of IBS in our cohort was 12.8%
The inability to defer defecation for more than 15 minutes occurred more
commonly in Group A patients (46.6%) versus Group B (21.8%) and Group
C (27.7%) and this was statistically significant (p=0.009).
In Group A, 46 patients (63%) had no residual sphincter defect, 10
patients (13.7%) had an isolated internal anal sphincter (IAS) defect,
5 patients (6.9%) had an isolated external anal sphincter defect (EAS),
and 12 patients (16.4%) had a defect in both IAS and EAS. There was no
significant difference in Wexner score in relation to localisation or
combination of sphincter defects and there was no difference in Wexner
score between those patients that had any sphincter defect versus those
that did not (Table 2). Group A patients had significantly higher mean
Wexner scores than Group B and C patients. Perfect continence (Wexner
score 0) was significantly less present in Group A (21.9%) patients
compared with Group B (50.9%) and Group C (45.8%) (Table 3). There was
no difference between Groups in number of patients with Wexner scores of
9 and above.
When the presence of IBS was taken into account, Wexner scores were
significantly higher in patients with IBS and this was observed
separately in all three patient groups. Inter-group comparison showed
that when IBS was present, Group A patients had significantly higher
Wexner scores than Group B and C patients. Interestingly when IBS was
absent there was no significant difference between Wexner scores in
inter-group comparison of all three groups (Table 4).
Wexner scores were also found to be significantly higher on intra-group
comparison in all three groups based on those that could not defer
defaecation longer than 15 minutes (Table 5). Inter-group comparison
showed that Group A patients maintained significantly higher Wexner
irrespective of whether they were able to defer defaecation for 15
minutes. Furthermore, the inability to defer defaecation for more than
15 minutes was not significantly related to an isolated IAS defect (7/34
vs 5/39, p=0.37), isolated EAS defect (1/34 vs 4/39, p=0.22), both IAS
and EAS defect (8/34 vs 2/39, p=0.79) or any sphincter defect (14/34 vs
13/39, p=0.49).
For the total group, IBS presence in combination with inability to defer
defaecation for 15 minutes was associated with the highest Wexner score
(Table 6). Backwards stepwise linear regression including the following
variables: age, IAS and or EAS ultrasonographic sphincter defect
(isolated or in combination), parity, presence of IBS, inability to
defer defaecation more than 15 minutes and BMI was performed. In the
final model (adjusted R-square .241, F=.7.68, p=0.002) presence of IBS
(Beta=3.48, p=0.002) and inability to defer defaecation for more than 15
minutes (Beta=2.17, p=0.044) were the significant independent factors
predicting increasing Wexner scores in Group A patients.