Andrews Vasanth, Shelmeridine Susan, Sultan Abdul H, Thakar Ranee
Croydon University Hospital, London Road, Croydon, Surrey, CR7 7YE, UK.
Int Urogynecol J. 2013 Jan;24(1):55-60. doi: 10.1007/s00192-012-1835-7. Epub 2012 Jul 4.
Our purpose was to establish the incidence of anal and urinary incontinence 4 years following vaginal delivery in women with and without obstetric anal sphincter injuries (OASIS).
This was a prospective study of 241 having their first vaginal delivery who had independent verification and repair of OASIS by trained obstetricians. All obstetricians performing OASIS repairs had undergone structured hands-on training and were then directly supervised while repairing OASIS until they were deemed competent to repair independently. Patients were followed up for 4 years with validated bowel and urinary questionnaires. In order to minimise nonresponders, contact details were verified and obtained from their general practitioners, the local primary care trust and electoral roll.
Two hundred and fifty-four women were invited, and 241 (95 %) participated. Fifty-nine (25 %) women sustained OASIS. One hundred and forty-nine were contactable 4 years later, and 86 (58 %) agreed to participate in the study at 4 years. No woman had faecal incontinence, and there was no difference in rates of flatus incontinence prior to delivery up to 4 years postpartum, regardless of whether OASIS occurred or not. Urinary incontinence was more than four times more common after vaginal birth, and this was not affected by whether OASIS occurred and resulted in a significant deterioration in quality of life.
The previously reported higher rates of anal incontinence following OASIS can be minimised up to 4 years after delivery if repaired by trained doctors. There is a significant increase in urinary incontinence following vaginal delivery, and the mechanism for this is not linked to anal sphincter disruption.
我们的目的是确定有无产科肛门括约肌损伤（OASIS）的女性在阴道分娩4年后肛门和尿失禁的发生率。
这是一项对241名首次阴道分娩女性的前瞻性研究，这些女性的OASIS由训练有素的产科医生进行独立核查和修复。所有进行OASIS修复的产科医生都接受了结构化的实践培训，然后在修复OASIS时接受直接监督，直到被认为有能力独立修复。使用经过验证的肠道和泌尿问卷对患者进行4年的随访。为了尽量减少无应答者，从她们的全科医生、当地初级医疗信托机构和选民名册中核实并获取了联系方式。
邀请了254名女性，241名（95%）参与。59名（25%）女性发生了OASIS。4年后有149名可联系上，其中86名（58%）同意在4年时参与研究。没有女性出现大便失禁，无论是否发生OASIS，在分娩前至产后4年期间，排气失禁的发生率没有差异。阴道分娩后尿失禁的发生率高出四倍多，且这不受是否发生OASIS的影响，并导致生活质量显著下降。
如果由训练有素的医生进行修复，此前报道的OASIS后较高的肛门失禁发生率在分娩后4年内可降至最低。阴道分娩后尿失禁显著增加，其机制与肛门括约肌破裂无关。
