Irritable bowel syndrome worsens faecal incontinence after primary
repair of major obstetric anal sphincter injuries (OASIS): a prospective
cohort study
Abstract
Objective: Obstetric anal sphincter injuries (OASIS) occur in
approximately 3-6% of vaginal deliveries and are the leading risk
factor for late onset faecal incontinence. We aimed to assess the effect
of irritable bowel syndrome (IBS) on severity of faecal incontinence
after immediate primary repair of major OASIS (Grade IIIb-IV). Design:
Prospective cohort study Setting: Zaans Medisch Centrum, Zaandam, The
Netherlands Population: Women who underwent a primary repair of major
OASIS over a 2-year period (Group A), a control group consisting of
primigravid women (Group B), and another control group who underwent
elective Caesarean section (Group C). Methods: Participants were
assessed with ultrasonography within 12 weeks, then a follow-up
questionnaire after at least 12 months. Main outcome: Wexner faecal
incontinence scores and presence of IBS based on Rome IV criteria.
Results: There were 211 total patients included, and mean follow-up time
was 26 months after sphincter repair. Ultrasonographic sphincter defects
were detected in 37% but did not affect faecal incontinence score
(p=0.16). Patients with IBS had significantly worse faecal incontinence
(p<0.001), and interestingly in women with OASIS those without
IBS had comparable symptoms to the control groups. Inability to defer
defaecation for 15 minutes was also associated with worse faecal
incontinence (p=0.003). Conclusion: After OASIS repair faecal
incontinence was significantly worsened by the presence of IBS, or in
women with an inability to defer defaecation. Presence of
ultrasonographic sphincter defects did not correlate to a clinical
difference in faecal incontinence scores. Funding: Nil. Keywords: OASIS,
sphincter, irritable bowel syndrome, incontinence