Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review Article Swipe
Martino Zacchè
,
Jayasish Ghosh
,
Ilias Liapis
,
Chioma Chilaka
,
Pallavi Latthe
,
Philip Toozs‐Hobson
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1002/nau.25235
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1002/nau.25235
Aims Obstetric anal sphincter injury (OASI) is associated with long‐term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth‐degree tear more likely to cause AI over a third‐degree tear? Methods A systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross‐sectional and case‐control studies without language restrictions. The quality was assessed by the Newcastle‐Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI. Results Out of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross‐sectional studies. Length of follow‐up ranged from 1 month to 23 years, with the majority of the reports ( n = 16) analysing data within 12‐months postpartum. Third‐degree tears evaluated were 6454 versus 764 fourth‐degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two‐ to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth‐degree tears, but this failed to reach statistical significance. Cross‐sectional studies with long‐term (≥5 years) follow‐up showed that women with fourth‐degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow‐up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth‐degree tear and FI. Conclusions Most studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long‐term follow‐up should be performed to evaluate the risk of AI for each OASI subtype.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1002/nau.25235
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/nau.25235
- OA Status
- bronze
- Cited By
- 6
- References
- 44
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4383872035
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4383872035Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1002/nau.25235Digital Object Identifier
- Title
-
Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic reviewWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-07-10Full publication date if available
- Authors
-
Martino Zacchè, Jayasish Ghosh, Ilias Liapis, Chioma Chilaka, Pallavi Latthe, Philip Toozs‐HobsonList of authors in order
- Landing page
-
https://doi.org/10.1002/nau.25235Publisher landing page
- PDF URL
-
https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/nau.25235Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
bronzeOpen access status per OpenAlex
- OA URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/nau.25235Direct OA link when available
- Concepts
-
Medicine, Tears, Prospective cohort study, Anal sphincter, Retrospective cohort study, Cohort study, Checklist, Fecal incontinence, Cohort, Gynecology, Obstetrics, Surgery, Internal medicine, Cognitive psychology, PsychologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
6Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 4, 2023: 2Per-year citation counts (last 5 years)
- References (count)
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44Number of works referenced by this work
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-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.long‐term | 10, 244, 331 |
| abstract_inverted_index.postpartum. | 158 |
| abstract_inverted_index.prospective | 74, 123 |
| abstract_inverted_index.statistical | 239 |
| abstract_inverted_index.consistently | 208 |
| abstract_inverted_index.incontinence | 12, 214 |
| abstract_inverted_index.heterogeneity | 319 |
| abstract_inverted_index.respectively. | 184 |
| abstract_inverted_index.restrictions. | 85 |
| abstract_inverted_index.retrospective | 76, 127, 206, 272 |
| abstract_inverted_index.significance. | 240 |
| abstract_inverted_index.significantly | 281 |
| abstract_inverted_index.Third‐degree | 159 |
| abstract_inverted_index.case‐control | 81 |
| abstract_inverted_index.third‐degree | 60 |
| abstract_inverted_index.fourth‐degree | 51, 166, 232, 252, 303 |
| abstract_inverted_index.Cross‐sectional | 241 |
| abstract_inverted_index.cross‐sectional | 79, 132 |
| abstract_inverted_index.Newcastle‐Ottawa | 92 |
| cited_by_percentile_year.max | 98 |
| cited_by_percentile_year.min | 94 |
| corresponding_author_ids | https://openalex.org/A5019832777 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 6 |
| corresponding_institution_ids | https://openalex.org/I4210099987 |
| citation_normalized_percentile.value | 0.85369481 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |