Introduction
Anal incontinence (AI) is a very distressing condition that occurs in up
to 15% of women (1) However the true incidence is likely to be higher
as only a third of women with incontinence ever report this to their
physician (2). Disruption of the anal sphincter caused by obstetric
injury (Obstetric anal sphincter injury (OASI)), or anorectal operations
are the most common causes of AI (3). It is estimated that 51% of
patients reported some degree of AI following OASI (4). Third-degree
tears occur during 2-6 % of vaginal deliveries and are usually repaired
by obstetrician-gynaecologists, but “occult” sphincter injury that are
unrecognized at delivery may occur in up to one-third of deliveries (5).
AI following childbirth may result from sphincter damage or nerve
injury, or both (6).
The most common finding is a defect in the anterior external anal
sphincter, which often manifests clinically as urgency of defecation and
faecal urge incontinence. Associated disruption of the internal
sphincter may cause additional symptoms of passive or stress AI (7).
Conservative therapies (stool bulking agents, antidiarrheals and pelvic
floor exercises/biofeedback) are the mainstay of initial treatment, with
reported improvement of up to 80% (8). When conservative treatment
fails, a sphincteroplasty or sacral nerve stimulation are commonly
offered. Most reports on AS repair for faecal incontinence in the
literature are uncontrolled case series mostly using the trans-perineal
approach. There are very few studies comparing sphincteroplasty with
other treatments.
Short term success rates for anal sphincter repair are up to 80%. This
reduces to 50% when patients were followed up for more than 5 years in
a systematic review (1). In asymptomatic females, aging is associated
with reduced anal resting and squeeze pressures, reduced rectal
compliance, reduced rectal sensation, and perineal laxity (9).
Although AI deteriorates over the long-term following anal
sphincteroplasty, patient QOL and satisfaction with improved control
remain relatively high (1).
Prognostic factors associated with less favourable outcomes include
advanced patient age, longer duration of incontinence and postoperative
wound infection (10).
Over recent years there has been a number of changes and improvements,
particularly in diagnostic techniques using ultrasound imaging of the
AS. There has also been an introduction of other novel treatments such
as Sacral Neuromodulation and Anal Bulking which have led to a decline
in this procedure partly due to its poor long-term results in the
current literature.
The objective of our study was to examine the long-term functional
outcomes following transvaginal anal sphincter repair for faecal
incontinence.