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Updated: Oct 3, 2025

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Under-classified obstetric anal sphincter injuries
Joanna C Roper1, Ranee Thakar1,2, Abdul H Sultan3,4
1Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK.
Under-classified obstetric anal sphincter injuries (OASIs) can lead to persistent defects and worse incontinence. Improved diagnosis of internal anal sphincter (IAS) tears shows progress, suggesting enhanced training can reduce misclassifications.
Area of Science:
- Obstetrics and Gynecology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Obstetric anal sphincter injuries (OASIs) are common childbirth injuries.
- Missed or under-classified OASIs can result in persistent anal sphincter defects and long-term consequences.
- Inadequate repair due to misclassification can lead to significant anorectal dysfunction and incontinence.
Purpose of the Study:
- To identify women with persistent anal sphincter defects on endoanal ultrasound inconsistent with their initial OASI diagnosis.
- To compare the impact of under-classified OASIs on St Mark's Incontinence Scores (SMIS).
- To analyze trends in OASI under-classification over time.
Main Methods:
- Retrospective review of endoanal ultrasound records from a perineal clinic (2012-2020).
- Identification of women with defects exceeding their initial OASI classification, specifically focusing on external and internal anal sphincter (IAS) involvement.
- Comparison of SMIS between women with different degrees of OASI under-classification.
Main Results:
- Out of 1056 women with diagnosed 3a or 3b tears, 120 (11.36%) had defects greater than initially classified.
- Women diagnosed with a 3b tear but having an IAS defect showed significantly higher SMIS (p < 0.01).
- A significant improvement in the diagnosis of IAS tears was observed between two 4-year periods.
Conclusions:
- Under-classification of OASIs is associated with worse anorectal symptoms, likely due to incomplete repairs.
- Improvements in diagnosing IAS tears have been noted, indicating progress in OASI detection.
- Enhanced training for healthcare professionals in OASI identification and management is recommended to reduce misclassifications and improve patient outcomes.
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