Table 2.
Clinical outcomes of obstetric anal sphincter injuries at 3 months postnatally (excluding the 3 patients with rectal buttonhole tears)
| Number of women (%) | Total (N = 1147) |
3a tear (n = 422) |
3b tear (n = 420) |
3c tear (n = 160) |
Ungraded third-degree tear grade (n = 83) | Fourth0degree tear (n = 62) |
p valuea OR, 95% CI |
p valueb OR, 95% CI |
p valuec OR, 95% CI |
|---|---|---|---|---|---|---|---|---|---|
| dFlatal incontinence (%) | 135 (11.8) | 32 (7.6) | 61 (14.5) | 13 (8.1) | 13 (15.9) | 16 (25.8) |
0.01* OR = 1.8, 1.2–2.7 |
0.27 |
< 0.01* OR = 2.8, 1.6–5.1 |
| dFaecal incontinence (%) | 45 (3.9) | 7 (1.7) | 13 (3.1) | 12 (7.5) | 8 (9.8) | 5 (8.1) |
0.02* OR = 2.7, 1.1–6.2 |
0.001* OR = 3.3, 1.6–7.0 |
0.08 |
| dFaecal urgency (%) | 90 (7.9) | 21 (5.0) | 31 (7.4) | 20 (12.5) | 13 (15.9%) | 5 (8.1) |
0.02* OR = 1.8, 1.1–3.1 |
0.01* OR = 2.2, 1.3–3.8 |
0.92 |
| Mean St. Mark’s incontinence score ± SD | 1.9 ± 3.7 | 1.1 ± 2.6 | 1.8 ± 3.5 | 2.5 ± 4.5 | 4.3 ± 4.9 | 1.8 ± 3.6 | < 0.01 | < 0.01* | < 0.01* |
| Urinary incontinence (%) | 189 (16.5) | 70 (16.6) | 68 (16.2) | 22 (13.8) | 18 (22.0) | 11 (17.7) | 0.40 | 0.46 | 0.96 |
| Mean ICIQ-UI score | 1.9 ± 3.8 | 1.8 ± 3.7 | 1.5 ± 3.2 | 1.6 ± 3.7 | 5.1 ± 6.5 | 2.0 ± 4.2 | 0.33 | 0.84 | 0.81 |
| Wound infection (%) | 31 (2.7) | 6 (1.4) | 13 (3.1) | 3 (1.9) | 6 (7.3) | 3 (4.8) | 0.16 | 0.76 | 0.23 |
| Wound dehiscence (%) | 38 (3.3) | 5 (1.2) | 15 (3.6) | 4 (2.5) | 9 (11.0) | 5 (8.1) | 0.71 | 0.64 | 0.18 |
| Dyspareunia (%) | 27 (2.4) | 9 (2.1) | 7 (1.7) | 3 (1.9) | 6 (7.3) | 2 (3.2) | 0.63 | 0.98 | 0.65 |
| Perineal pain (%) | 77 (6.7) | 21 (5.0) | 23 (3.5) | 13 (8.1) | 15 (18.3) | 5 (8.1) | 0.42 | 0.15 | 0.64 |
| Vaginal adhesion/perineal sinus (%) | 13 (1.1) | 3 (0.7) | 6 (1.4) | 1 (0.6) | 3 (3.7) | 0 | 0.44 | 0.61 | 1.0 |
| Granulation tissue (%) | 25 (2.2) | 5 (1.2) | 8 (1.9) | 3 (1.9) | 7 (8.5) | 2 (3.2) | 0.38 | 0.76 | 0.67 |
| Stitch migration (%) | 4 (0.3) | 1 (0.2) | 0 | 0 | 0 | 3 (4.8) | 0.24 | 0.66 |
< 0.01* OR: 55.1, 5.6–538.0 |
| Fistula (%) | 7 (0.06) | 0 | 0 | 1 (0.63) | 3 (3.66) | 3 (3.66) | 0.14 | 0.07 |
0.01* OR: 6.0, 1.2–30.3 |
| Urogenital prolapse (%) | 10 (0.9) | 3 (0.7) | 1 (0.2) | 4 (2.5) | 2 (2.4) | 0 | 0.80 |
0.008* OR = 5.4, 1.3–21.7 |
1.0 |
| Anal fissure (%) | 29 (2.5) | 9 (2.1) | 13 (3.1) | 4 (2.5) | 3 (3.7) | 0 | 0.44 | 0.93 | 0.4 |
| Mean size of perineal body | 2.5 ± 2.0 | 2.5 ± 0.7 | 2.5 ± 0.7 | 2.5 ± 0.5 | 2.4 ± 0.6 | 2.0 ± 0.7 | 1.0 | 1.0 | < 0.01* |
| Anal manometry results | |||||||||
| Mean resting pressure (mmHg) ± SD | 50.3 ± 14.3 | 53.1 ± 13.5 | 50.1 ± 13.6 | 48.0 ± 16.4 | 47.3 ± 16.1 | 40.3 ± 10.4 | < 0.01* | 0.007* | < 0.01* |
| Maximum squeeze pressure (mmHg) ± SD | 94.6 ± 22.0 | 93.4 ± 27.3 | 85.1 ± 26.2 | 83.6 ± 29.4 | 81.0 ± 21.9 | 68.1 ± 19.0 | < 0.01* | 0.04* | < 0.01* |
| Maximum cough reflex pressure (mmHg) ± SD | 73.6 ± 22.5 | 79.2 ± 20.8 | 71.6 ± 21.7 | 72.8 ± 25.8 | 71.0 ± 25.7 | 60.1 ± 14.1 | < 0.01* | 0.41 | < 0.01* |
| Maximum incremental rise ± SD | 36.6 ± 21.0 | 40.4 ± 22.7 | 35.0 ± 20.0 | 35.5 ± 21.0 | 33.7 ± 14.9 | 28.3 ± 15.4 | < 0.01* | 0.28 | < 0.01* |
| Mean anal length (cm) ± SD | 2.4 ± 0.5 | 2.4 ± 0.5 | 2.3 ± 0.5 | 2.3 ± 0.6 | 2.2 ± 0.5 | 2.3 ± 0.6 | 0.004* | 0.43 | 0.14 |
| Endoanal ultrasound results | |||||||||
| Defect in EAS (%) | 213 (18.6) | 36 (8.6) | 88 (21.0) | 43 (26.9) | 16 (19.3) | 30 (48.4) |
< 0.01* OR = 3.1, 2.1–4.6 |
< 0.01* OR = 2.2, 1.5–3.3 |
< 0.01* OR: 4.9, 2.9–8.4 |
| Defect in IAS (%) | 196(17.0) | 23 (5.5) | 67 (16.0) | 50 (31.3) | 14 (16.9) | 42 (67.7) |
< 0.01* OR = 4.4, 2.7–7.0 |
< 0.01* OR = 3.9, 2.6–5.9 |
< 0.01* OR: 14.5, 8.0–26.1 |
95% CI = 95% confidence interval; EAS = external anal sphincter; IAS = internal anal sphincter; ICIQ-UI = International Consultation on Incontinence modular Questionnaire for Urinary Incontinence; OR = odds ratio; SD = standard deviation
*Statistically significant p value
a: comparing between 3a and 3b/c tear grade
b: comparing between 3a/b and 3c tear grade
c: comparing between overall third- and fourth-degree tear