Department of Obstetrics and Gynecology, Division of Urogynecology, Amphia Hospital, Breda, The Netherlands.
Department of Obstetrics and Gynecology, Division of Urogynecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Ultrasound Obstet Gynecol. 2021 Sep;58(3):476-482. doi: 10.1002/uog.23525.
Obstetric anal sphincter injury (OASI) is an important factor in the etiology of anal incontinence. This study aimed to evaluate whether anal sphincter defects, levator avulsion or levator ballooning after OASI are associated with severity of anal incontinence. Furthermore, we evaluated whether factors such as constipation and altered stool consistency are associated with symptoms of incontinence after OASI.
In this multicenter prospective observational cohort study, women with OASI were invited to participate at least 3 months after primary repair. All women completed validated questionnaires, including St Mark's incontinence score, Bristol stool scale (BSS) and Cleveland clinic constipation score (CCCS), and underwent four-dimensional (4D) transperineal ultrasound for assessment of the levator ani muscle and anal sphincter.
In total, 220 women were included. Median follow-up was 4 months (range, 3-98 months). Univariate linear regression analysis showed an association of St Mark's incontinence score with a residual defect of the external anal sphincter (EAS) (β, 1.55 (95% CI, 0.04-3.07); P = 0.045), higher parity (β, 0.85 (95% CI, 0.02-1.67); P = 0.046), BSS (β, 1.28 (95% CI, 0.67-1.89); P < 0.001) and CCCS (β, 0.36 (95% CI, 0.18-0.54); P < 0.001). However, multivariate linear regression found an association of St Mark's incontinence score only with BSS (β, 1.50 (95% CI, 0.90-2.11); P < 0.001) and CCCS (β, 0.46 (95% CI, 0.29-0.63); P < 0.001).
Residual defects of the EAS, detected on 4D transperineal ultrasound, are associated with severity of anal incontinence symptoms measured using St Mark's incontinence score 4 months after OASI repair. Furthermore, clinical factors such as constipation and altered stool consistency appear to influence this association and may therefore play a more important role in clinical management. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
产科肛门括约肌损伤（OASI）是肛门失禁的重要病因。本研究旨在评估 OASI 后肛门括约肌缺陷、提肌撕裂或提肌膨出是否与肛门失禁的严重程度有关。此外，我们还评估了便秘和粪便稠度改变等因素是否与 OASI 后失禁症状有关。
本研究为多中心前瞻性观察队列研究，邀请 OASI 后的女性至少在初次修复后 3 个月参加。所有女性均完成了验证后的问卷，包括 St Mark 失禁评分、Bristol 粪便量表（BSS）和克利夫兰诊所便秘评分（CCCS），并进行了 4D 经会阴超声检查，以评估肛提肌和肛门括约肌。
共纳入 220 名女性。中位随访时间为 4 个月（范围 3-98 个月）。单变量线性回归分析显示，St Mark 失禁评分与肛门外括约肌（EAS）残余缺陷（β，1.55（95%CI，0.04-3.07）；P=0.045）、更高的产次（β，0.85（95%CI，0.02-1.67）；P=0.046）、BSS（β，1.28（95%CI，0.67-1.89）；P<0.001）和 CCCS（β，0.36（95%CI，0.18-0.54）；P<0.001）有关。然而，多变量线性回归仅发现 St Mark 失禁评分与 BSS（β，1.50（95%CI，0.90-2.11）；P<0.001）和 CCCS（β，0.46（95%CI，0.29-0.63）；P<0.001）有关。
4D 经会阴超声检测到的 EAS 残余缺陷与 OASI 修复后 4 个月的 St Mark 失禁评分测量的肛门失禁症状严重程度有关。此外，便秘和粪便稠度改变等临床因素似乎影响了这种关联，因此在临床管理中可能发挥更重要的作用。© 2020 年国际妇产科超声学会。
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