Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study
Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study
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DOI：
10.1007/bf02235567
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发表时间：
2000-05-01
影响因子：
3.9
通讯作者：
Mignon, M
中科院分区：
文献类型：
--
作者：
Abramowitz, L;Sobhani, I;Mignon, M
肛门失禁影响大约10%的成年女性。肛门括约肌的损伤被认为是产后肛门失禁的原因，这是迄今为止唯一的前瞻性研究。本研究的目的是前瞻性地确定产后肛门失禁和肛门括约肌损伤的发生率及其与产科参数的关系。方法：我们研究了259名连续的女性分娩前6周和分娩后8周。他们被要求填写一份评估大便失禁的问卷。然后进行肛门超声内镜检查（7-10 MHz）。两名独立观察员分析了肛门内外括约肌。结果：共有233例患者（90%）接受了评估，其中31例进行了剖宫产。16.7%（14%为外括约肌，1.7%为内括约肌，1%为内括约肌和外括约肌）的新生缺陷仅发生在阴道分娩后的产后。第一次和第二次分娩后，这些中断的发生率相同。多变量分析显示，括约肌缺损的独立危险因素（比值比，95%置信区间）为产钳术（12; 4-20）、会阴撕裂（16; 9-25）、会阴切开术（G.G; 5-17）和产次（8.8; 4-19）。肛门失禁的总发生率为9%，独立危险因素（比值比：95%置信区间）包括产钳（4.5; 1.5-13）、会阴撕裂（3.9; 1.4-10.3）、括约肌缺损（5.5; 5-15）和产程延长（3.4; 1-11）。在这些患者中，只有45%有括约肌缺陷。结论：产后肛门失禁是多因素的，肛门括约肌缺损仅占45%。初产和次产患者发生括约肌断裂和肛门失禁的危险因素相同。由于肛门外括约肌损伤比肛门内括约肌损伤更常见，有症状的患者应考虑手术修复。
Anal incontinence affects approximately 10 percent of adult females. Damage to the anal sphincters has been considered as the cause of anal incontinence after childbirth in the sole prospective study so far available. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth and their relationship with obstetric parameters. METHODS: We studied 259 consecutive females six weeks before and eight a weeks after delivery. They were asked to fill in a questionnaire assessing fecal incontinence. Anal endosonography (7-10 MHz) was then performed. Two independent observers analyzed internal and external anal sphincters. RESULTS: A total of 233 patients (90 percent) were assessed, of whom 31 had cesarean section. De novo sphincter defects were observed in 16.7 percent (14 percent external, 1.7 percent internal, and 1 percent both) in the postpartum period only after vaginal delivery. These disruptions occurred with the same incidence after the first and the second childbirth. independent risk factors (odds ratio, 95 percent confidence interval) for sphincter defect were forceps (12; 4-20), perineal tears (16; 9-25), episiotomy (G.G; 5-17), and parity (8.8; 4-19) as revealed by multivariate analyses. The overall rate of anal incontinence was 9 percent and independent risk factors (odds ratio: 95 percent confidence interval) involved forceps (4.5; 1.5-13), perineal tears (3.9; 1.4-10.3), sphincter defect (5.5; 5-15), and prolonged labor (3.4; 1-11). Among these patients only 45 percent had sphincter defects. CONCLUSION: Anal incontinence after delivery is multifactorial, and anal sphincter defects account for only 45 percent of them. Primiparous and secundiparous patients have the same risk factors for sphincter disruption and anal incontinence. Because external anal sphincter disruptions are more frequent than internal anal sphincter damage, surgical repair should be discussed in symptomatic patients.