Vehof, D.F. (Demi) (2024) No increased risk of long-term anal incontinence after a subsequent vaginal delivery compared to a caesarean section following obstetric anal sphincter injury A retrospective cohort study with prospective follow-up. thesis, Medicine.
Full text available on request.Abstract
Objective: Obstetric anal sphincter injury (OASI) is a cause of anal incontinence (AI). AI includes flatus and faecal incontinence. The mode of subsequent delivery is a topic of debate. Caesarean section protects against recurrent OASI, but it is unclear how a subsequent delivery affects the risk of long-term incontinence. This study aimed to establish the long-term prevalence of AI after OASI and assess the influence of mode of delivery on AI. Methods: This single-centre cohort study with a prospective follow-up included women with a history of OASI between 2009 and 2021. 431 patients were invited to complete a questionnaire, including the Wexner Score, St Marks Incontinence Score and Faecal Incontinence Quality of Life scale to assess AI symptoms and quality of life. Results: 287 women completed the questionnaire. Median follow-up was 6 years (range 2-15 years). AI was reported by 129 (44.9%) women. In the major tear group (grade 3c and 4), 14 (21.2 %) reported solid faecal incontinence compared to 14 (6.5 %) in the minor group (grade 3a and 3b, (OR 3.37, 95% CI 1.5-7.5). Although not significant, women with a subsequent caesarean section reported more AI compared to women with a subsequent vaginal delivery (55.2% vs. 32.7%, OR 1.79; 95% CI 0.65-4.90). Conclusion: The prevalence of AI following OASI was 45%. Women with a major tear have a threefold risk of solid faecal incontinence compared to those with a minor tear. Mode of subsequent delivery did not significantly affect the risk of long-term AI in women counselled based on symptoms and sphincter integrity. Keywords: Obstetric anal sphincter injury, anal incontinence, follow-up, mode of delivery
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Massop-Helmink, Drs. D.S. and Arendsen, Dr. L.P. |
| Faculty: | Medical Sciences |
| Date Deposited: | 03 Dec 2025 13:21 |
| Last Modified: | 03 Dec 2025 13:21 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3867 |
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