ABSTRACT
Objective: Obstetric anal sphincter injuries (OASIS) occur in
approximately 3-6% of vaginal deliveries and are the leading risk
factor for late onset faecal incontinence. We aimed to assess the effect
of irritable bowel syndrome (IBS) on severity of faecal incontinence
after immediate primary repair of major OASIS (Grade IIIb-IV).
Design: Prospective cohort study
Setting: Zaans Medisch Centrum, Zaandam, The Netherlands
Population: Women who underwent a primary repair of major OASIS
over a 2-year period (Group A), a control group consisting of
primigravid women (Group B), and another control group who underwent
elective Caesarean section (Group C).
Methods: Participants were assessed with ultrasonography within
12 weeks, then a follow-up questionnaire after at least 12 months.
Main outcome: Wexner faecal incontinence scores and presence of
IBS based on Rome IV criteria.
Results: There were 211 total patients included, and mean
follow-up time was 26 months after sphincter repair. Ultrasonographic
sphincter defects were detected in 37% but did not affect faecal
incontinence score (p=0.16). Patients with IBS had significantly worse
faecal incontinence (p<0.001), and interestingly in women with
OASIS those without IBS had comparable symptoms to the control groups.
Inability to defer defaecation for 15 minutes was also associated with
worse faecal incontinence (p=0.003).
Conclusion: After OASIS repair faecal incontinence was
significantly worsened by the presence of IBS, or in women with an
inability to defer defaecation. Presence of ultrasonographic sphincter
defects did not correlate to a clinical difference in faecal
incontinence scores.
Funding: Nil. Keywords: OASIS, sphincter injury,
irritable bowel syndrome, incontinence