A prospective cohort study of women after primary repair of obstetric analsphincter laceration

OBJECTIVE: This study was undertaken to prospectively assess subjective ano rectal symptoms by questionnaire and to prospectively assess the integrity of the anal sphincter by physical and ultrasonographic examination in women with and without obstetric anal sphincter laceration. STUDY DESIGN: Fifteen subjects who sustained obstetric anal sphincter lacer ations at the time of vaginal delivery were matched with 15 control subject s and followed up prospectively. Women underwent physical and ultrasonograp hic evaluations and answered questionnaires regarding anorectal symptoms at 6 weeks and at 4 months post partum. Data were evaluated with the Fisher e xact test, the Wilcoxon exact and signed rank tests, and the McNemar test. RESULTS: On postpartum examination the subjects with lacerations had more s eparated sphincters and decreased anal resting and squeeze tones with respe ct to control subjects (P < .05). According to ultrasonographic evaluation the anal sphincters were more commonly disrupted in the laceration group th an in the control group (external anal sphincter, 40% vs 20%; P = .43; and internal anal sphincter, 47% vs 7%; P = .035). Subjective rating of fecal i ncontinence was significantly greater in the laceration group than in the c ontrol group (P < .05). There was no correlation between fecal incontinence symptoms and the integrity of the external anal sphincter. At the 4-month visit, fecal incontinence was resolved in 36% of subjects; however, continu ed anorectal dysfunction was reported by 43% of subjects in the laceration group versus only 7% of the control subjects (P = .08). CONCLUSION: Reports of fecal incontinence were significantly greater among women with a history of primarily repaired obstetric anal sphincter lacerat ions than among control subjects. Ultrasonographic examination revealed sep arated anal sphincters in 40% of the women with obstetric anal sphincter la cerations, despite repair at the time of delivery.