Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints.

OBJECTIVE: To determine the long-term effects of obstetric anal sphincter rupture on the frequency of faecal incontinence and sexual complaints. DESIGN: Retrospective case-control study. SETTING: Department of Gynaecology and Obstetrics, Ikazia Hospital, The Netherlands. POPULATION: All 171 women operated for anal sphincter rupture between 1971 and 1990 and 171 controls matched for parity and date of delivery. METHODS: Postal questionnaires regarding faecal incontinence were sent in 1996 and 2005 to all cases and controls with questions regarding sexual complaints added to the questionnaire in 2005. MAIN OUTCOME MEASURES: Anorectal complaints defined as any form of faecal incontinence including faecal urgency and faecal soiling. Sexual complaints defined as dyspareunia or faecal incontinence during intercourse. RESULTS: Sixty-one percent of the women responded to both questionnaires. Anorectal complaints were reported by 38% of case versus 16% of controls in 1996 (risk difference: 0.22, 95% CI 0.10-0.34) and by 61% of cases versus 22% of controls in 2005 (risk difference: 0.41, 95% CI 0.29-0.53). In contrast to the control group, the increase of anorectal complaints in the case group between 1996 and 2005 was highly significant (P < 0.0001). Postmenopausal state was not associated with an increased risk for faecal incontinence. Dyspareunia was reported by 29% of cases versus 13% of controls (P = 0.01). Faecal incontinence during intercourse was reported by 13% of cases versus 1% of controls (P = 0.005). CONCLUSIONS: Obstetric anal sphincter rupture is an important risk factor for sexual complaints and for faecal incontinence increasing with age irrespective of menopausal state.