Long-term cost of fecal incontinence secondary to obstetric injuries.

INTRODUCTION: Anal incontinence is eight times more frequent in females than in males because of injuries sustained at childbirth. The aim of the present study was to determine the long-term costs associated with anal incontinence related to obstetric injuries. METHODS: Sixty-three patients with anal incontinence caused by obstetric sphincter injuries answered questionnaires regarding previous treatments, symptoms, and use of protective products. Of the patients, 31 were treated surgically, 11 with biofeedback, 6 with a combination of surgery and biofeedback, and 15 conservatively. Treatments and their respective costs were obtained from patient records, patient questionnaires, billing database, and Health Care Financing Administration's 1996 inpatient database. Costs were expressed in 1996 dollars. RESULTS: The mean incontinence score changed from 26 at evaluation to 16 at follow-up (P < 0.001). The average cost per patient was $17,166. Evaluation and follow-up charges totaled $65,412, and physiologic assessment accounted for 64 percent of these costs. Treatment charges totaled $559,341, and physician charges accounted for 18 percent of these charges. CONCLUSIONS: Fecal incontinence after childbirth results in substantial economic costs, and treatment is not always successful. New treatment modalities, such as artificial bowel sphincter or dynamic graciloplasty, should be assessed to determine their cost-effectiveness.

Anal incontinence after vaginal delivery: a prospective study in primiparous women.

OBJECTIVE: To investigate the incidence and degree of anal incontinence after vaginal delivery among primiparous women and to define associated risk factors. DESIGN: Prospective observational study. SETTING: Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital. PARTICIPANTS: Three hundred and forty-nine primiparous women. METHODS: Questionnaires distributed within the first days after delivery and re-distributed five and nine months postpartum. Analysis of delivery records. RESULTS: Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1% of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery. CONCLUSIONS: The present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.

Perineal body measurement improves evaluation of anterior sphincter lesions during endoanal ultrasonography.

UNLABELLED: Endoanal ultrasonography has become an important tool in the evaluation of patients with anal incontinence. However, the extent of anterior defects is sometimes difficult to quantitate during endoanal ultrasonography. PURPOSE: This study was designed to evaluate perineal body measurement during endoanal ultrasonography in assessing patients with obstetric anal sphincter injuries. METHODS: Forty-two patients with anal incontinence because of obstetric sphincter injuries and 13 asymptomatic subjects were investigated with endoanal ultrasonography. Sphincter muscle thickness, sphincter defects, and perineal body were measured. Perineal body measurement was performed by inserting a finger, held gently against the posterior vaginal wall, into the vagina and measuring the distance between the inner surface of the internal sphincter and the ultrasonographic reflection of the finger. RESULTS: All patients had anterior sphincter lesions of varying extent. Mean size of internal sphincter lesions was 146 degrees, and mean size of external sphincter lesions was 107 degrees (P < 0.001). Perineal body measurement was performed without difficulty in all patients and subjects. Perineal body measurement (mean +/- standard deviation) was 6 +/- 2 mm in patients and 12 +/- 3 mm in asymptomatic subjects (P < 0.001). Ninety-three percent of patients had perineal body measurement < or = 10 mm, and 70 percent of asymptomatic subjects had perineal body measurement > 10 mm. Digital delineation of the perineal body during endoanal ultrasonography improved the visualization of sphincter lesions in 74 percent of patients. CONCLUSIONS: Digital delineation of the perineal body during endoanal ultrasonography improved the visualization of sphincter lesions in the majority of patients. Perineal body measurement is performed without difficulty and is a good predictor of anterior sphincter lesions. Use of this technique improves visualization of sphincter lesions.