Fecal incontinence after anal sphincter injury during vaginal delivery

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Fecal incontinence after anal sphincter injury
during vaginal delivery the effect of
increasing age and menopause
J.W. de Leeuw MD PhD, S. Muller MD Dept.
of Obstetrics and Gynecology, Ikazia Hospital,
Rotterdam, the Netherlands
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Aim and design of the study

• To asses the role of
• Anal sphincter injury during delivery in the
  occurrence of anorectal and sexual
  complaints more than 20 years after delivery
• Increasing age and menopause on the rate of
  anorectal complaints in women with a
  history of anal sphincter damage during delivery

• Design
• 171 women with anal sphincter injury and matched
  controls
• January 1st 1971 December 31st 1990
• 1995/1996 1st postal questionnaire 147 cases
  and 125 controls
• 2004/2005 2nd postal questionnaire 102 cases
  and 68 controls

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Results (in )

• Cases Controls
• Fecal inco () 1996 2005 1996 2005
• Grade-II 25 42 15 13
• Grade-III IV 10 14 4 5
• Total 34 56 19 18
• Vaizey-score gt8 6 12 4 4
• , plt 0,05 plt 0,001

Menopause Post- 44 inco Pre- 62
inco (NS) Age gt 50 years gt 50 53 inco lt
50 61 inco (NS)
Dyspareunia 30 15 (plt 0,05) Fecal inco during
coïtus 13 2 (plt 0,01)
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Conclusions

• Anal sphincter injury during delivery is strongly
  associated with fecal incontinence 25 years after
  delivery, irrespective of menopausal state or age
• This association is even stronger compared with
  the situation 15 years after delivery, and
  complaints tend to become more serious over time
• Anal sphincter injury during delivery is
  significantly associated with dyspareunia and
  fecal incontinence during coitus