Lessons from a one-stop multidisciplinary perineal clinic for obstetric anal sphincter injury (OASI): An early Asian...

Obstetric anal sphincter injuries (OASIs) affect 6% of nulliparous women and 2% of parous women, with Asian ethnicity as a recognised risk factor. To provide comprehensive post-OASI care, a multi-disciplinary perineal clinic was set up in 2022 at Singapore's largest maternity hospital. This study aimed to characterise women reviewed in the clinic and describe medium-term outcomes at 3-6 months postpartum.

Anonymised data of 62 women attending the clinic between January 2022 and December 2023 were extracted from the hospital's database and analysed. Standardised evaluation included symptom assessment, pelvic floor physiotherapy referral and attendance review, and counselling regarding further investigations such as endoanal ultrasound and anorectal manometry. Symptomatology and impact of incontinence on quality of life were reviewed.

The commonest grade of OASI was 3 A (48.4%), followed by 3B (25.8%), 3 C (14.5%) and 4 (9.7%). Prevalence of flatus incontinence and faecal incontinence was 17.7%. Other symptoms included urinary incontinence (54.8%), perineal pain (9.7%), sexual dysfunction (30.6%), and psychological concerns (4.8%). Prior to clinic review, 40.3% of women had attended at least one PFPT session. This increased to 64.5% after clinic review, representing an absolute increase of 15 women and a relative increase of 60.0%. Eleven women (17.7%) required referral to other specialist services, including seven to a combined pelvic floor clinic.

Women reviewed 3-6 months after OASI experienced a substantial burden of pelvic floor symptoms. A multidisciplinary perineal clinic provided coordinated assessment, counselling, and onward referral in this post-OASI population. Higher PFPT attendance observed after clinic review suggests that multidisciplinary counselling may support engagement with postpartum rehabilitation, although causal relationships cannot be established in this descriptive audit.