Popis: |
There is still scarce and contradictory information about the long-term severity and subjective impact of anal incontinence in women after one or two consecutive obstetrical anal sphincter injuries (OASIs).To describe the severity and impact of anal incontinence in two-para women two decades after birth, analyze the relative effect of one versus two OASIs compared with women with no OASI and the possible influence of OASI on other pelvic floor disorders.We linked prospectively registered data in the Swedish Medical Birth Register to information from a postal and web-based questionnaire in 2015. Statistics Sweden identified women with two vaginal births from 1992 to 1998, and a simple random sample of 11,000 women was drawn from a source cohort of 64,687 women. To achieve equal-sized groups of women with one and two OASIs, the latter group was oversampled from 1987 to 2000. The final study cohorts consisted of 6760 women with no OASI, 357 with one, and 324 with two OASIs. Third- and fourth-degree perineal tears were analyzed as one group. Anal incontinence was either fecal or isolated gas incontinence, and fecal incontinence was involuntary leakage of solid or liquid stool, with or without concomitant gas. Frequencies of leakage of stool and gas were dichotomized into low frequency (less than once a month) and high frequency (several times a month or more often). Pairwise comparisons were analyzed using Fisher´s exact test, Mantel-Haenszel statistics, and the Mann-Whitney U-test. Trends were analyzed with Mantel-Haenszel statistics and the Spearman´s rank correlation test. Logistic regression models obtained the age and body mass index (kg/m2) adjusted odds ratio (aOR) for outcomes. Statistical significance was set to P.05.The response rate was 65.5% in the randomly selected cohort and 70.1% in women with two OASIs. Bothersome fecal incontinence occurred in 3.3% (212/6458) of women without OASI, in 10.4% (36/345) (aOR, 3.25; 95% CI, 2.23-4.73) of those with one, and 16.5% (52/315) (aOR, 5.16; 95% CI, 3.69-7.22) with two OASIs (Trend P.0001). Fecal incontinence was perceived as bothersome in 28.2% (212/753) of women without OASI, compared to 43.9% (36/82) and 46.0% (52/113) in those with one or two OASIs (Trend P.0001). Leakage of liquid stool occurred in 10.8% (724/6717) of those without injury, in 21.7% (77/355) of women with one, and 34.9% (113/324) with two OASIs (Trend P.0001). Incontinence affecting daily life was reported by 8.6% (577/6672) of women without, and 19.7% (69/351) and 29.6% (96/324) in women with one and two sphincter injuries (Trend P.0001). The mean Jorge-Wexner score was 2.44, 3.26, and 3.88 in women with no, one, and two sphincter injuries (Trend P.0001). In women with a Jorge-Wexner score of six,50% had bothersome anal incontinence. The overall effect of one versus two OASIs on measures of anal incontinence was aOR, 2.19 (95% CI, 1.68-2.85) and aOR 3.91 (95% CI, 3.06-5.00) compared to no OASI (both P.0001). No significant effect of one or two OASIs on other pelvic floor disorders or lower urinary tract symptoms was observed (P .73 and P .69).A consistent additive effect of one or two sphincter injuries on the severity and impact of anal incontinence was observed in women two decades after two vaginal births. This information is important for health care economics, clinical practice, and policy. |