Delivery, and anal incontinence later in life

Česká verzia

Authors: J. Štěpán jr.; J. Karbanová; V. Kališ; P. Chaloupka; J. Landsmanová; J. Nosek; Z. Bukačová; Z. Rokyta
Authors place of work: Gynekologicko-porodnická klinika LF UK a FN, Plzeň, přednosta doc. MUDr. Z. Rokyta, CSc.
Published in the journal: Ceska Gynekol 2010; 75(1): 4-8

Summary

Objective:
Evaluation of the mutual relationship between delivery and late anal incontinence.

Design:
Review.

Setting:
Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen.

Summary:
Anal incontinence is a symptom often referred to by women between the ages of 40 and 60. However, it seems, that only a small number of such cases might be related to obstetric perineal trauma.

According to recent data, elective Caesarean section only plays a small protective role. Its effect is restricted to the first few years after delivery.

With time, the function of the anal sphincter gradually deteriorates. Subsequent deliveries might contribute to this functional impairment. The long-term effect of forceps delivery is still not clear.

The extent of anal sphincter trauma (particularly the defect of the internal anal sphincter) seems to have an impact on the development of anal incontinence, even years after the event.

Overlooking defects of the anal sphincter is a cause of problems long after delivery. Given the unsatisfactory results of secondary overlapping, and also, relatively good preliminary effect of primary repair, careful observence of the recommended steps leading to the correct diagnostics of obstetric perineal trauma is crucial, as is adequate repair.

Key words:
vaginal delivery, Caesarean section, anal incontinence.

Zdroje

1. Akervall, S., Nordgren, S., Fasth, S., et al. The effects of age, gender, and parity on rectoanal functions in adults. Scand J Gastroenterol, 1990, 25(12), p. 1247-1256.

2. Allen, RE., Hosker, GL., Smith, AR., Warrell, DW. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol, 1990, 97(9), p. 770-779.

3. Andrews, V., Sultan, AH., Thakar, R., Jones, PW. Occult anal sphincter injuries – myth or reality? BJOG, 2006, 113(2), p. 195-200.

4. Bannister, JJ., Abouzekry, L., Read, NW. Effect of aging on anorectal function. Gut, 1987, 28(3), p. 353-357.

5. Bartolo, DCC., Read, NW., Jarratt, JA., et al. Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent. Gastroenterology, 1983, 85, p. 68-75.

6. Belai, A., Wheeler, H., Burnstock, G. Innervation of the rat gastrointestinal sphincters: changes during development and aging. Int J Dev Neurosci, 1995, 13(2), p. 81-95.

7. Bharucha, AE. Fecal incontinence. Gastroenterology, 2003, 124(6), p. 1672-1685.

8. Bharucha, AE., Zinsmeister, AR., Locke, GR., et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology, 2005, 129(1), p. 42-49.

9. Bollard, RC., Gardiner, A., Duthie, GS., Lindow, SW. Anal sphincter injury, fecal and urinary incontinence: a 34-year follow-up after forceps delivery. Dis Colon Rectum, 2003, 46(8), p. 1083-1088.

10. Damon, H., Bretones, S., Henry, L., et al. Long-term consequences of first vaginal delivery-induced anal sphincter defect. Dis Colon Rectum, 2005, 48(9), p. 1772-1776.

11. Faltin, DL., Otero, M., Petignat, P., et al. Women’s health 18 years after rupture of the anal sphincter during childbirth: I. Fecal incontinence. Am J Obstet Gynecol, 2006, 194(5), p. 1255-1259.

12. Felt-Bersma, RJ., Gort, G., Meuwissen, SG. Normal values in anal manometry and rectal sensation: a problem of range. Hepatogastroenterology, 1991, 38(5), p. 444-449.

13. Fornell, EU., Matthiesen, L., Sjodahlm R., Berg, G. Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG, 2005, 112(3), p. 312-316.

14. Fox, JC., Fletcher, JG., Zinsmeister, AR., et al. Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum, 2006, 49(11), p. 1726-1735.

15. Fynes, M., Donnelly, V., Behan, M., et al. Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet, 1999, 354, p. 983-967.

16. Fynes, M., Donnelly, VS., O’Connell, PR., O’Herlihy, C. Cesarean delivery and anal sphincter injury. Obstet Gynecol, 1998, 92(4 Pt 1), p. 496-500.

17. Goldberg, RP., Kwon, C., Gandhi, S., et al. Prevalence of anal incontinence among mothers of multiples and analysis of risk factors. Am J Obstet Gynecol, 2003, 189(6), p. 1627-1630; discussion 1630-1631.

18. Groom, KM., Paterson-Brown, S. Can we improve on the diagnosis of third degree tears? European J Obstet Gynecol Reprod Biol, 2002, 101(1), p. 19-21.

19. Haadem, K., Dahlstrom, JA., Ling, L. Anal sphincter competence in healthy women: clinical implications of age and other factors. Obstet Gynecol, 1991, 78(5 Pt 1), p. 823-827.

20. Halverson, AL., Hull, TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum, 2002, 45(3), p. 345-348.

21. HŅjberg, KE., Salvig, JD., Winslow, NA., et al. Flatus and faecal incontinence: prevalence and risk factors at 16 weeks of gestation. Br J Obstet Gynaecol 2000, 107, p. 1097-1103.

22. Jameson, JS., Chia, YW., Kamm, MA., et al. Effect of age, sex and parity on anorectal function. Br J Surg, 1994, 81(11), p. 1689-1692.

23. Kalis, V., Chaloupka, P., Turek, J., Rokyta, Z. Risk factors for 3rd and 4th degree perineal ruptures during delivery. Čes Gynek, 2005, 70(1), p. 30-36.

24. Kalis, V., Chaloupka, P., Turek, J., et al. Vaginal delivery in primiparas and anal incontinence. Čes Gynek, 2003, 68(5), p. 312-320.

25. Lagier, E., Delvaux, M., Vellas, B., et al. Influence of age on rectal tone and sensitivity to distension in healthy subjects. Neurogastroenterol Motil, 1999, 11(2), p. 101-107.

26. Laurberg, S., Swash, M. Effects of aging on anorectal sphincters and their inneravtion. Dis Colon rectum, 1989, 32, p. 737-742.

27. MacArthur, C., Glazener, CM., Wilson, PD., et al. Obstetric practice and faecal incontinence three months after delivery. BJOG, 2001, 108(7), p. 678.

28. MacArthur, C., Glazener, C., Lancashire, R., et al. Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study. BJOG, 2005, 112(8), p. 1075-1082.

29. Madoff, RD., Parker, SC., Varma, MG., Lowry, AC. Faecal incontinence in adults. Lancet, 2004, 364(9434), p. 621-632.

30. Malouf, AJ., Norton, CS., Engel, AF., et al. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet, 2000, 355(9200), p. 260-265.

31. McHugh, SM., Diamant, NE. Effect of age, gender, and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci, 1987, 32(7), p. 726-736.

32. Nelson, RL. Epidemiology of fecal incontinence. Gastroenterology, 2004, 126(1) Suppl 1, p. S3-7.

33. Nelson, R., Furner, S., Jesudason, V. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum, 1998, 41(10), p. 1226-1229.

34. Nygaard, IE., Rao, SS., Dawson, JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol, 1997, 89, p. 896-901.

35. Okonkwo, JE., Obionu, CN., Okonkwo, CV., Obiechina, NJ. Anal incontinence among Igbo (Nigerian) women. Int J Clin Pract, 2002, 56, p. 178-180.

36. Perry, S., Shaw, C., McGrother, C., et al., Leicestershire MRC Incontinence Study Team. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut, 2002, 50(4), p. 480-484.

37. Poen, AC., Felt-Bersma, RJ., Dekker, GA., et al. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol, 1997, 104, p. 563-566.

38. Poen, AC., Felt-Bersma, RJ., Strijers, RL., et al. Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg, 1998, 85, p. 1433-1438.

39. Pollack, J., Nordenstam, J., Brismar, S., et al. Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol, 2004, 104(6), p. 1397-1402.

40. Poos, RJ., Frank, J., Bittner, R., Beger, HG. Influence of age and sex on anal sphincters: manometric evaluation of anorectal continence. Eur Surg Res, 1986, 18(6), p. 343-348.

41. Rao, SS., Hatfield, R., Soffer, E., Rao, S., et al. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol, 1999, 94(3), p. 773-783.

42. Ryhammer, AM., Bek, KM., Laurberg, S. Multiple vaginal deliveries increase the risk of permanent incontinence of flatus urine in normal premenopausal women. Dis Colon Rectum, 1995, 38, p. 1206-1209.

43. Ryhammer, AM., Laurberg, S., Sorensen, FH. Effects of age on anal function in normal women. Int J Colorectal Dis, 1997, 12(4), p. 225-229.

44. Sangalli, MR., Floris, L., Faltin, D., Weil, A. Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynaecol, 2000, 40(3), p. 244-248.

45. Sloots, CE., Felt-Bersma, RJ., Cuesta, MA., Meuwissen, SG. Rectal visceral sensitivity in healthy volunteers: influences of gender, age and methods. Neurogastroenterol Motil, 2000, 12(4), p. 361-368.

46. Snooks, SJ., Barnes, PRH., Swash, M., Henry, MM. Damage to the innervation of the pelvic floor musculature in chronic constipation. Gastroenterology, 1985, 89, p. 977-981.

47. Snooks, SJ., Setchell, M., Swash, M., Henry, MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet, 1984, 2(8402), p. 546-550.

48. Snooks, SJ., Swash, M., Mathers, SE., Henry, MM. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg, 1990, 77(12), p. 1358-1360.

49. Sultan, AH., Kamm, MA., Hudson, CN. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol, 1994, 101(1), p. 22-28.

50. Sultan, AH., Kamm, MA., Hudson, CN., et al. Anal-sphincter disruption during vaginal delivery. N Engl J Med, 1993, 329(26), p. 1905-1911.

51. Sultan, AH., Nicholls, RJ., Kamm, MA., et al. Anal endosonography and correlation with in vitro and in vivo anatomy. Br J Surg, 1993, 80, p. 508-511.

52. Šlauf, P. Anální inkontinence. Postgrad Med, 2000, 2, p. 422-427.

53. Womack, NR., Morrison, JFB., Williams, NS. The role of pelvic floor denervation in the aetiology of idiopathic faecal incontinence. Br J Surg, 1986, 73, p. 404-407.

54. Zetterström, J., López, A., Anzén, B., et al. Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol, 1999, 94, p. 21-28.

55. Zorcolo, L., Covotta, L., Bartolo, DC. Outcome of anterior sphincter repair for obstetric injury: comparison of early and late results. Dis Colon Rectum, 2005, 48(3), p. 524-531.