Abstract:
Abstract
OBJECTIVE: Anal incontinence occurs as a result of damage to pelvic floor and
the anal sphincter. In women, vaginal delivery has been recognized as the primary
cause. To date, figures quoted for overt third degree anal sphincter tear vary
between 0% and 26.9% of all vaginal deliveries and the prevalence of anal
incontinence following primary repair vary between 15% and 61%. Our aim was to
analyse the long-term (minimum 10 years post primary repair) anorectal function
and quality of life in a cohort of women who suffered a third degree tear (Group 1)
and compare the results with a cohort of women who underwent an uncomplicated
vaginal delivery (Group 2) or an elective caesarean delivery (Group 3).
METHOD: In all, 107 patients who suffered a third degree tear between 1981 and
1993 were contacted with a validated questionnaire. The two control groups
comprised of 125 patients in each category. Those who responded to the
questionnaire were invited for anorectal physiology studies and endoanal
ultrasound.
RESULTS: Of the total number contacted, 54, 71 and 54 women from the three
groups returned the completed questionnaire. In the three groups, a total of 28
(53%), 13 (19%) and six (11%) complained of anal incontinence (P < 0.0001)
respectively. Comparison of quality of life scores between the groups showed a
poorer quality of life in those who suffered a tear (P < 0.0001). In addition, in spite
of primary repair, 13 (59%) patients in group 1 showed a persistent sphincter
defect compared to one (4%) occult defect in Group 2 and none in Group 3.
CONCLUSION: Our study indicates that long-term results of primary repair are not
encouraging. It therefore emphasizes the importance of primary prevention and
preventing further sphincter damage in those who have already suffered an injury
(during subsequent deliveries).
