Kargın Süleyman, Çifçi Sami, Kaynak Adnan, Ataseven Hüseyin, Kadıyoran Cengiz, Çakır Murat
Medova Private Hospital, Clinic of General Surgery, Konya, Turkey.
Karaman State Hospital, Clinic of Gastroenterology, Karaman, Turkey.
Turk J Obstet Gynecol. 2017 Mar;14(1):37-44. doi: 10.4274/tjod.56650. Epub 2017 Mar 15.
Obstetric anal sphincter injuries are one of the most significant complications of vaginal delivery that give way to fecal incontinence, which is defined as the involuntary leakage of gas, fluid or solid stool. Although sphincter injuries are seen in 0.5-9% of all deliveries. It has been reported that 20-41% of women who had vaginal deliveries had occult anal sphincter injuries as endoanal ultrasonography began to be used by physicians. The aim of our study was to investigate the relationship between fecal incontinence, whose incidence increases dramatically during the postmenopausal stage, and occult anal sphincter injuries.
Two hundred healthy female patients with no history of anal sphincter injury, aged between 18 and 70 years were included in the study. The participants were divided into 4 groups according to their menopausal stages and mode of delivery; premenopausal (group 1) and postmenopausal (group 2) vaginal delivery, and premenopausal (group 3) and postmenopausal (group 4) cesarean section. Wexner incontinence scores were determined. The participants' defects were assessed using endoanal ultrasound and their status of fecal incontinence using anorectal manometric measurements.
Anorectal manometric measurement results were found significantly lower in group 1 than in group 3 (p<0.01). The Wexner scores of groups 1 and 3 were similar. The anorectal manometric measurement results of group 2 were significantly lower than those of group 4, and the Wexner score of group 2 was significantly higher than other groups (p=0.03).
Anal sphincter injuries formed after vaginal delivery may be one of the reasons that increase the incidence of postmenopausal fecal incontinence and cause the formation of fecal incontinence symptoms in women.
产科肛门括约肌损伤是阴道分娩最严重的并发症之一，可导致大便失禁，大便失禁定义为气体、液体或固体粪便的不自主泄漏。尽管在所有分娩中，括约肌损伤的发生率为0.5%-9%。据报道，随着医生开始使用腔内超声检查，20%-41%经阴道分娩的女性存在隐匿性肛门括约肌损伤。本研究的目的是调查在绝经后阶段发病率急剧增加的大便失禁与隐匿性肛门括约肌损伤之间的关系。
本研究纳入了200名年龄在18至70岁之间、无肛门括约肌损伤病史的健康女性患者。参与者根据绝经阶段和分娩方式分为4组；绝经前（第1组）和绝经后（第2组）阴道分娩，以及绝经前（第3组）和绝经后（第4组）剖宫产。测定韦克斯纳失禁评分。使用腔内超声评估参与者的缺陷，并使用肛门直肠测压测量其大便失禁状况。
发现第1组的肛门直肠测压测量结果显著低于第3组（p<0.01）。第1组和第3组的韦克斯纳评分相似。第2组的肛门直肠测压测量结果显著低于第4组，且第2组的韦克斯纳评分显著高于其他组（p=0.03）。
阴道分娩后形成的肛门括约肌损伤可能是绝经后女性大便失禁发病率增加并导致大便失禁症状形成的原因之一。
