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Anatomic and functional evaluation of the levator ani muscle after an obstetric anal sphincter injury

  • Eva Martínez FrancoEmail author
  • José Luís López Negre
  • David Parés
  • Cristina Ros Cerro
  • Lluís Amat Tardiu
  • Daniel Cuadras
  • Montserrat Espuña Pons
General Gynecology
  • 16 Downloads

Abstract

Purpose

To study the relationship between symptoms of anal incontinence (AI) and the anatomy and functionality of the levator ani muscle in women with a history of obstetric anal sphincter injury (OASI).

Methods

This is a cohort study including patients with OASI from 2013 to 2016. Patients were assessed by a physical examination, endoanal ultrasound using Starck Scale, perineometry and 4D transperineal ultrasound. AI in all patients was measured with the Wexner scale. Correlation between variables has been analyzed in these patients.

Results

72 patients were analyzed: 28 with a IIIA degree tear, 26 with a IIIB, 13 with a IIIC and 5 with a IV. 38 patients showed a residual anal sphincter (AS) defect on endoanal ultrasound with an average Starck score of 6.5 ± 3.7. 21 patients expressed AI, with an average Wexner score of 4.1 ± 2.4. In 27 (37.5%) patients, a levator ani avulsion was observed: 17 unilateral and 10 bilateral. Patients with a levator ani defect had weaker pelvic floor muscle (PFM) function. These differences were statistically significant with perineometry (p = 0.01 and p = 0.03) but not for the Oxford test (p = 0.08). Patients with a residual AS defect as well as an injury to the levator ani muscle expressed greater AI symptomatology than patients with residual sphincter injury who maintain the integrity of the levator ani: Wexner 4.9 0.9 vs 3.3 1 (p = 0.02).

Conclusions

The PFM has correlation with AI symptom development in patients with a history of OASI. Therefore, we suggest a key role of anatomical and functional assessments of the levator ani muscle in these patients.

Keywords

Anal sphincter obstetric injury Anal incontinence Levator ani 

Notes

Acknowledgements

We thank Sra Emma Herrero for her contribution in patient recruitment and schedule.

Author contributions

EMF: project development and data collection; JLLN: data collection; DP: manuscript editing; CRC: project development; LlAT: manuscript editing; DC: data analysis; MEP: project development.

Funding

Study was awarded with a local Research Grant of the Parc Sanitari Sant Joan de Déu and the Sant Joan de Déu Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Eva Martínez Franco
    • 1
    Email author
  • José Luís López Negre
    • 2
  • David Parés
    • 3
  • Cristina Ros Cerro
    • 4
  • Lluís Amat Tardiu
    • 5
  • Daniel Cuadras
    • 6
  • Montserrat Espuña Pons
    • 4
  1. 1.Obstetrics and Gynecology Department, Parc Sanitari Sant Joan de DéuUniversitat de BarcelonaSant Boi de LlobregatSpain
  2. 2.General and Digestive Surgery Department, Parc Sanitari Sant Joan de DéuUniversitat de BarcelonaSant Boi de LlobregatSpain
  3. 3.Colorectal Surgery Unit, General and Digestive Surgery Department, Hospital Germans Trias I PujolUniversitat Autónoma de BarcelonaBadalonaSpain
  4. 4.Obstetrics and Gynecology Department, Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
  5. 5.Obstetrics and Gynecology Department, Hospital Sant Joan de DéuUniversitat de BarcelonaEsplugues de LlobregatSpain
  6. 6.Statistical and Methodological DepartmentSant Joan de Déu Research FoundationEsplugues de LlobregatSpain

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