Follow-up of postpartum anal sphincter injuries

A number of women who incur anal sphincter injuries during childbirth develop severe anal incontinence. The purpose of our study was to survey the follow-up and treatment of anal sphincter injuries in the first two years postpartum.

Data on all women who have undergone vaginal birth with the diagnosis code third or fourth degree perineal rupture in Norway in the period 1.1.2012-31.12.2013 were obtained from the Medical Birth Registry of Norway. These data were linked to the Norwegian Patient Registry to chart any treatment with sacral neuromodulation or sphincteroplasty up to two years postpartum. A questionnaire survey of procedures for following up patients with perineal rupture was also conducted among maternity departments in Norway.

1 999 women had suffered third or fourth degree perineal rupture during childbirth during the study period. Twelve (0.6 %) of them had undergone sphincteroplasty, while none had been treated with sacral neuromodulation. Almost all of them were followed up by the hospital 6-12 months after giving birth, but few hospitals used a validated scoring system to assess the degree of anal incontinence.

Very few women with third or fourth degree perineal rupture were treated for severe anal incontinence with sphincteroplasty or sacral neuromodulation within two years of giving birth.