Results of a Systematic Intensive Follow-Up of 259 Cases of Obstetric Anal Sphincter Injury

BACKGROUND: Obstetric anal sphincter injury (OASI) is a complication of childbirth. Some women will develop symptoms, which may appear in the short or long term. In most clinical practice guidelines, follow-up is only recommended in women with anal incontinence (AI). In our hospital, follow-up is offered to all women who suffer an OASI: Anorectal manometry (ARM) and endoanal ultrasound (EAUS) are scheduled for all patients. The aim of this study was to determine if a symptom-based or systematic follow-up was better for these patients. To do so, we compared the results of investigations (EAUS and ARM) between asymptomatic and symptomatic women.METHODS: A retrospective analysis of prospectively collected data from 259 women who suffered an OASI in a single tertiary hospital in Barcelona (Spain) between May 2008 and May 2018.RESULTS: Seventy-seven percent of women attended the first follow-up visit at the perineal clinic, and 40.5% of women completed the 12-month follow-up. At initial evaluation, 60% of the patients had a Wexner score of 0. Seventy-two percent of women had an abnormal result on one or both investigations (EAUS and ARM). CONCLUSIONS: Attendance and adherence to our follow-up protocol are low. Although the incidence of AI symptoms is low at early follow-up in women after OASI, they show a high rate of functional dysfunctions on manometry. If follow-up is offered only to symptomatic patients, it could lead to an underestimation of their true condition.