Long-term outcome after obstetric injury: a retrospective study

Objective. To examine problems experienced by women after vaginal delivery with and without a sphincter tear and compare those with less and more severe injuries. Design. Retrospective questionnaire study. Setting. Regional hospital in Sweden. Sample. A total of 324 women with and 309 without sphincter tears. Methods. Questionnaires were sent out four to eight years after delivery enquiring about the existence and time course of gas incontinence, fecal incontinence, dyspareunia and perineal pain. A question about vacuum delivery was also included. Main outcome measures. Prevalence of persisting symptoms. Results. The reply rate was 77%. About 10% of the women with a sphincter tear had fecal incontinence initially, compared with 3% among those without a sphincter tear. In women with moderate or severe tears, 20 and 31%, respectively, had gas incontinence, compared with 6% of women without a tear. Dyspareunia and perineal pain were present 1823% of women in the tear groups compared with 912% of those without a tear. Almost 45% of women with initial symptoms had remaining problems after four to eight years. There was a significantly higher risk for symptoms after vacuum extraction (p < 0.001). Conclusions. Gas incontinence, fecal incontinence, dyspareunia and perineal pain were common problems after delivery. The prevalence of persisting symptoms was high even among women without a tear. The higher prevalence after vacuum extraction delivery indicates that there are more complications associated with this mode of delivery than previously thought.