Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome?

INTRODUCTION This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. MATERIALS AND METHODS Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire and anorectal physiology results. RESULTS Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 +/- 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% +/- 14.41% vs. 19.75% +/- 15.65%, P= 0.002) and Wexner scores (6.00 +/- 3.76 vs. 3.67 +/- 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% +/- 14.9% vs. 17.01 +/- 13.87%, P= 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P= 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. DISCUSSION In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. CONCLUSIONS Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.