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The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence.

Starck-Söndergaard, Marianne LU ; Bohe, Måns LU and Valentin, Lil LU (2006) In Ultrasound in Obstetrics & Gynecology 27(2). p.188-197
Abstract
Objective

To describe and classify endosonographic obstetric sphincter defects at 1 week, 3 months and 1 year after primary repair, and to relate the endosonographic results to anal sphincter pressure and to symptoms of anal incontinence over time.



Methods

Forty-one women who had suffered a third- or fourth-degree perineal tear at delivery underwent anal endosonography and anal manometry 1 week, 3 months and 1 year after primary suture of the tear. The extent of the endosonographic defects was described using defect scores ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extent of the defect. The women answered a... (More)
Objective

To describe and classify endosonographic obstetric sphincter defects at 1 week, 3 months and 1 year after primary repair, and to relate the endosonographic results to anal sphincter pressure and to symptoms of anal incontinence over time.



Methods

Forty-one women who had suffered a third- or fourth-degree perineal tear at delivery underwent anal endosonography and anal manometry 1 week, 3 months and 1 year after primary suture of the tear. The extent of the endosonographic defects was described using defect scores ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extent of the defect. The women answered a questionnaire with regard to bowel function 1 and 4 years after delivery, the degree of incontinence being expressed as a Wexner score.



Results

Some 90% (37/41) of the women had endosonographic defects at 1 week, 3 months and 1 year. The endosonographic defect scores increased significantly between the first and second examinations and then remained unchanged. At 1 year there was a negative correlation between endosonographic sphincter defect score and sphincter pressure. At 1 and 4 years, 54% (22/41) and 61% (25/41) of the women, respectively, had a Wexner score 1. There was a positive correlation between the endosonographic sphincter defect score at 1 week, 3 months and 1 year and the Wexner incontinence score at 1 and 4 years. The endosonographic sphincter defect score at 1 week was the variable that was most predictive of the Wexner score at 4 years (r = 0.48, P = 0.002).



Conclusion

The higher the endosonographic sphincter defect score after primary repair of an obstetric sphincter tear the lower the sphincter pressure and the higher the risk of anal incontinence. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
obstetric sphincter tears, endosonography, anal incontinence, anal manometry
in
Ultrasound in Obstetrics & Gynecology
volume
27
issue
2
pages
188 - 197
publisher
John Wiley & Sons
external identifiers
  • wos:000235372700013
  • scopus:33646766127
ISSN
1469-0705
DOI
10.1002/uog.2630
language
English
LU publication?
yes
id
01f263a3-4de8-4d80-a3bd-ec5b2c847cd1 (old id 147800)
date added to LUP
2007-07-30 16:21:42
date last changed
2019-02-17 04:13:11
@article{01f263a3-4de8-4d80-a3bd-ec5b2c847cd1,
  abstract     = {Objective<br/><br>
To describe and classify endosonographic obstetric sphincter defects at 1 week, 3 months and 1 year after primary repair, and to relate the endosonographic results to anal sphincter pressure and to symptoms of anal incontinence over time.<br/><br>
<br/><br>
Methods<br/><br>
Forty-one women who had suffered a third- or fourth-degree perineal tear at delivery underwent anal endosonography and anal manometry 1 week, 3 months and 1 year after primary suture of the tear. The extent of the endosonographic defects was described using defect scores ranging from 0 (no defect) to 16 (maximal defect), the score taking into account the location and the longitudinal and circumferential extent of the defect. The women answered a questionnaire with regard to bowel function 1 and 4 years after delivery, the degree of incontinence being expressed as a Wexner score.<br/><br>
<br/><br>
Results<br/><br>
Some 90% (37/41) of the women had endosonographic defects at 1 week, 3 months and 1 year. The endosonographic defect scores increased significantly between the first and second examinations and then remained unchanged. At 1 year there was a negative correlation between endosonographic sphincter defect score and sphincter pressure. At 1 and 4 years, 54% (22/41) and 61% (25/41) of the women, respectively, had a Wexner score 1. There was a positive correlation between the endosonographic sphincter defect score at 1 week, 3 months and 1 year and the Wexner incontinence score at 1 and 4 years. The endosonographic sphincter defect score at 1 week was the variable that was most predictive of the Wexner score at 4 years (r = 0.48, P = 0.002).<br/><br>
<br/><br>
Conclusion<br/><br>
The higher the endosonographic sphincter defect score after primary repair of an obstetric sphincter tear the lower the sphincter pressure and the higher the risk of anal incontinence.},
  author       = {Starck-Söndergaard, Marianne and Bohe, Måns and Valentin, Lil},
  issn         = {1469-0705},
  keyword      = {obstetric sphincter tears,endosonography,anal incontinence,anal manometry},
  language     = {eng},
  number       = {2},
  pages        = {188--197},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence.},
  url          = {http://dx.doi.org/10.1002/uog.2630},
  volume       = {27},
  year         = {2006},
}