Anal incontinence following obstetric anal sphincter injury : is there a difference between subtypes? A systematic review
Author
Zacchè, Martino MariaGhosh, Jayasish
Liapis, Ilias
Chilaka, Chioma
Latthe, Pallavi
Toozs-Hobson, Philip
Affiliation
Birmingham Women's Hospital; Walsall Healthcare NHS TrustPublication date
2023-09
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Aims: Obstetric anal sphincter injury (OASI) is associated with long-term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth-degree tear more likely to cause AI over a third-degree tear? Methods: A systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross-sectional and case-control studies without language restrictions. The quality was assessed by the Newcastle-Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI. Results: Out of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross-sectional studies. Length of follow-up ranged from 1 month to 23 years, with the majority of the reports (n = 16) analysing data within 12-months postpartum. Third-degree tears evaluated were 6454 versus 764 fourth-degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two- to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth-degree tears, but this failed to reach statistical significance. Cross-sectional studies with long-term (≥5 years) follow-up showed that women with fourth-degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow-up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth-degree tear and FI. Conclusions: Most studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long-term follow-up should be performed to evaluate the risk of AI for each OASI subtype.Citation
Zacchè MM, Ghosh J, Liapis I, Chilaka C, Latthe P, Toozs-Hobson P. Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review. Neurourol Urodyn. 2023 Sep;42(7):1455-1469Type
ArticlePMID
37431160Journal
Neurourology and UrodynamicsPublisher
Wileyae974a485f413a2113503eed53cd6c53
10.1002/nau.25235