Secondary sphincter repair for anal incontinence following obstetric sphincter injury - functional outcome and quality of life at 18-years follow-up

Barbosa M1, Glavind-Kristensen M2, Soerensen MM1, Christensen P1. Colorectal Dis. 2019 Jul 26. doi: 10.1111/codi.14792. [Epub ahead of print]


Author information

Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.

Pelvic Floor Unit, Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.


AIM: Secondary sphincter repair has been the conventional management of anal incontinence (AI) when a structural defect in the sphincter is recognized. However, disappointing long-term results have contributed to a tendency towards an increasing use of alternative treatment methods. This study aimed to assess the long-term functional outcomes following a secondary sphincter repair in women with AI after obstetric sphincter injury.

METHOD: This is a questionnaire study of women who underwent a secondary sphincter repair in Denmark between January 1990 and December 2005. Patients were identified through the Danish National Patient Registry. Functional outcomes were assessed by a self-administrated questionnaire in 2010 and 2018. Primary outcomes were Wexner and St. Mark's score. Impact on quality of life was assessed using the Fecal Incontinence Quality of life scale.

RESULTS: Functional outcome was assessed in 370 women in 2010 and 255 women in 2018. At 18.3 years of follow-up (IQR 15.0-22.0), mean Wexner score was 8.8 (SD ± 4.8) and mean St. Mark's score 11.7 (SD ± 5.0). Flatus incontinence was the most frequent symptom, reported by 97%. Incontinence for liquid and solid stools were reported by 75% and 54%, respectively. There were no significant changes in incontinence frequencies over time. Women with a Wexner score ≥9 had a significantly lower QoL-score in all domains compared to women with a Wexner score <9 (p<0.001).

CONCLUSION: At long-term follow-up, few patients are fully continent following a secondary sphincter repair. However, it appears that the functional results remain stable at very long-term follow-up. 

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