Complete rupture of anal sphincter in primiparas: long-term effects and subsequent delivery

摘要

Objective. To study long-term effects with respect to anal incontinence, pain, attitude to and mode of second delivery following complete rupture of the anal sphincter. Design. Case-control study. Settings. Sodersjukhuset, a university hospital in Stockholm. Population. A case group of 136 primiparas who had experienced a complete rupture of the anal sphincter. Two matched control groups of primiparas, one of whom had cesarean section and the other a normal vaginal delivery. Methods. The case women were examined and asked for symptoms of anal incontinence 3-6 months after delivery; 3-8 years later they and two matched control groups answered a postal questionnaire. Response rate was 89%. Main outcome measures. Symptoms of pelvic floor dysfunction and, as secondary end-point, the attitude to and mode of second delivery. Results. Anal incontinence after delivery was reported by 31% in the case group, and at long-term follow-up by 54% in the case group, 21% in the cesarean section and 23% in the normal delivery group (p < 0.0001). A wish to postpone or abandon further childbirth was significantly more common in the case women (33 and 18%) than in the other groups, but about 60% delivered again in all groups. In the case group, the next delivery was by cesarean section in 49%. Conclusion. At long-term follow-up after a complete rupture of the anal sphincter, anal incontinence was common and many women wished to postpone or avoid further delivery.