CONCLUSION
After primary repair of major OASIS, patients are less likely to retain
perfect continence compared to control groups. Ultrasonographic mostly
partial sphincter defects were detected in 37% of patients on follow
up, but this did not correlate to a clinical difference in faecal
incontinence scores. Faecal incontinence was significantly worsened by
the presence of IBS, or the inability to defer defaecation for 15
minutes. Women who did not have IBS had similar or minor incontinence
scores across the study groups of major OASIS repair, primigravid or
post-caesarean section.
We propose that the presence of IBS interacts with the complex
neuro-physiological coordination required for continence, which may be
exacerbated by Grade III/IV perineal trauma. Screening for presence of
IBS is therefore a useful tool to prognosticate the risk of faecal
incontinence after major OASIS, but also to assess future faecal
incontinence risk, if patients are known to be at high risk for OASIS,
in order to advise on optimal birthing options.