[Acceptability and results of postpartum proctological consultation for women who have had an obstetric injury of the anal sphincter]

Abstract

Objectives: Early management of perineal disorders after obstetric anal sphincter injury (OASI) may improve the functional prognosis. The objective was to assess the acceptability of the consultation and to report on its results.

Methods: This unicentric retrospective study included 64 women who had LOSA 3 or 4 and who were offered a 3-month routine postpartum proctological consultation. The proposed diagnoses and recoveries were identified.

Results: Of the 5,070 women who gave birth vaginally, 64 women had LOSA (1.2%). 54 came to the clinic (84.3%). At the interview, 21 women had no complaints. A diagnosis of evacuation disorders or hemorrhoidal disease in particular was made in 10 women. A specific management was proposed to 16 women and a control consultation was proposed to 3 women. Of the 33 women with at least one symptom, 31 women were diagnosed and 27 women were offered specific management. A monitoring consultation was offered to 18 women. The main diagnoses were gas incontinence, dyschesia with or without abdominopererial asynchronism and decreased sphincter tone. The main measures undertaken were the extension of laxatives, the proposal of perineal massage and abdominal-perineal rehabilitation by biofeedback.

Conclusion: Systematic proctological consultation was acceptable and allows for a specific management in the majority of cases. The assessment of its long-term impact remains to be defined.

Keywords: Bowel incontinence; Dyschesia; Dyschésie; Incontinence anale; Lésion obstétricale du sphincter anal; Obstetric anal sphincter injuries; Prise en charge; Treatment.