The following is a summary of “Severity and impact of accidental bowel leakage two decades after no, one, or two sphincter injuries,” published in the APRIL 2023 issue of Obstetrics and Gynecology by Nilsson, et al.
The limited and contradictory information regarding the long-term severity and subjective impact of anal incontinence in women following one or two consecutive obstetrical anal sphincter injuries (OASIs). For a study, researchers sought to describe the severity and impact of anal incontinence among women who had two previous deliveries two decades after giving birth. Additionally, the study analyzed the relative effects of one versus two OASIs compared to no OASIs and examined the potential influence of OASIs on other pelvic floor disorders.
Prospectively registered data from the Swedish Medical Birth Register were linked with information from a postal and web-based questionnaire conducted in 2015. A total of 11,000 women were randomly selected from a source cohort of 64,687 women who had undergone two vaginal births between 1992 and 1998. An oversampling strategy was used for women with two OASIs to ensure equal-sized groups. The final study cohorts included 6,760 women with no OASIs, 357 women with one OASI, and 324 women with two OASIs. Anal incontinence was defined as fecal or isolated gas incontinence, with fecal incontinence further defined as involuntary leakage of solid or liquid stool with or without concomitant gas. Statistical analyses, including logistic regression, were performed to calculate adjusted odds ratios and determine significance.
The response rates were 65.5% in the randomly selected cohort and 70.1% among women with two OASIs. Bothersome fecal incontinence was reported by 3.3% (212/6458) of women without OASIs, 10.4% (36/345) (adjusted odds ratio 3.25; 95% CI 2.23–4.73) of those with one OASI, and 16.5% (52/315) (adjusted odds ratio 5.16; 95% CI 3.69–7.22) of those with two OASIs (trend P<.0001). Fecal incontinence was perceived as bothersome in 28.2% (212/753) of women without OASIs compared to 43.9% (36/82) and 46.0% (52/113) of those with one or two OASIs, respectively (trend P<.0001). Leakage of liquid stool occurred in 10.8% (724/6717) of women without OASIs, 21.7% (77/355) of women with one OASI, and 34.9% (113/324) of women with two OASIs (trend P<.0001).
Incontinence affecting daily life was reported by 8.6% (577/6672) of women without OASIs and by 19.7% (69/351) and 29.6% (96/324) of women with one and two OASIs, respectively (trend P<.0001). The mean Jorge-Wexner score was 2.44, 3.26, and 3.88 for women with no OASIs, one OASI, and two OASIs, respectively (trend P<.0001). Among women with a Jorge-Wexner score of 6, more than 50% experienced bothersome anal incontinence. The adjusted odds ratios for the overall effect of one versus two OASIs on measures of anal incontinence were 2.19 (95% CI 1.68–2.85) and 3.91 (95% CI 3.06–5.00), respectively, compared to no OASIs (both P<.0001). One or two OASIs did not significantly affect other pelvic floor disorders or lower urinary tract symptoms (P=.73 and P=.69).
The study demonstrated a consistent and additive effect of one or two obstetrical anal sphincter injuries on the severity and impact of anal incontinence in women two decades after two vaginal births. The findings had important implications for healthcare economics, clinical practice, and policy development.