Department of Colorectal Surgery, Innlandet Hospital Trust Hamar, Hamar, Norway.
University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.
BMC Womens Health. 2020 Jun 22;20(1):131. doi: 10.1186/s12905-020-00989-5.
Aim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed.
All women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark's incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography.
In total 52,3% (n = 207) of the 396 invited women participated in the study. Mean St. Mark's score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury.
The prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark's incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment.
本研究旨在评估阴道分娩后女性产后肛门失禁的患病率，并评估产科肛门括约肌损伤的漏诊程度。
2015 年 1 月 1 日至 2016 年 6 月 30 日期间，在挪威因弗内斯医院信托埃尔弗吕姆分娩且会阴区接受任何缝合的初产妇和经产妇（无论产次）均被邀请回答圣马克失禁评分问卷，并接受包括直肠内超声在内的盆底临床检查。
共有 396 名受邀女性中的 52.3%（n=207）参与了研究。产后 14 个月（平均）时，检查时圣马克评分平均为 1.8 分（95%CI 1.4 至 2.1），且无参与者每周发生粪便漏出。粪便急迫感影响 11.7%（95%CI 7.1 至 16.3）的参与者，8.7%（95%CI 5.1 至 12.8）每周发生不可控的排气漏出。9 名女性（9.3%，95%CI 4.1 至 15.5）存在先前未检出的三度产科肛门括约肌损伤。
会阴 1 度和 2 度裂伤缝合的阴道分娩女性中，肛门失禁的患病率较低。一些产科肛门括约肌损伤在分娩时仍未被发现，但这些损伤引起的肛门失禁症状处于圣马克失禁评分的下半部分。对于持续性粪便急迫或气体和/或粪便漏出等症状的女性，应转诊至肛肠外科医生处进行评估，以获得最佳治疗。
