Long-term Symptoms and Satisfaction After Postpartum Secondary Sphincteroplasty

Objectives: Obstetrical anal sphincter injuries (OASIS) are a major cause of maternal morbidity following vaginal delivery. Primary repair of an OASIS is indicated immediately after delivery, however, approximately 3% of women with a history of OASIS will undergo a secondary repair of the sphincter due to wound infections, breakdown of the primary repair, or if there is an occult sphincter rupture in conjunction with anal incontinence. While short-term functional outcomes are promising, few patients are fully continent in the long term. The goal of this study was to assess subjective outcomes, satisfaction, and regret after secondary sphincteroplasty after OASIS.

Methods: This is a case series of women evaluated in a peripartum pelvic floor disorders clinic who ultimately underwent secondary sphincteroplasty after OASIS between March 2012 and May 2020. Women were sent surveys that included questions about continued symptoms of anal incontinence, associated quality of life measures, and interval obstetric history. The surveys included the Satisfaction with Decision Scale (SDS) and Accidental Bowel Leakage Evaluation (ABLE). Demographics, clinical information, and interval time data were obtained through chart review.

Results: Of the 40 women eligible for inclusion, only 32 had valid contact information and were sent surveys. 14 surveys were completed (44%). The average time between sphincteroplasty and completion of the survey was 6.8 years. Five women (36%) had a subsequent pregnancy after sphincteroplasty. The average ABLE score was 22.215.4. Eight women (57%) experience incontinence of liquid and/or solid stool, 10 women (71%) experience incontinence of gas and 11 women (79%) experience fecal urgency and/or a sense of incomplete emptying. Of those who continue to experience incontinence of liquid and/or solid stool, 3 women (38%) are “very” or “somewhat” bothered by it. Of those experiencing incontinence of gas, 7 women (70%) are “very” or “somewhat” bothered by it. Of those who experience fecal urgency and/or incomplete emptying one woman (8%) is “very” or “somewhat” bothered by it. The average SDS score was 32  3, with 86% (n=12) that “strongly agree” or “agree” that surgery was the right decision and would make the same decision again if given the option. One woman (7%) strongly agreed with the statement, “I regret the choice that was made,” while all others who completed the survey “Disagreed” or “Strongly disagreed” with that statement.

Conclusions: This survey-based case series demonstrates a high prevalence of anal leakage after secondary sphincteroplasty. However, moderate- to severe-bother was uncommon and there was a high prevalence of patient satisfaction after secondary sphincteroplasty, even in the setting of continued anal leakage.