Anal sphincter injury has lasting impact on sex life.(Gynecology)

MONTREAL -- Obstetric anal sphincter injuries can cause fecal incontinence for decades, and also may wreak havoc on a couple's sex life, according to Jan Willem de Leeuw, M.D., a consultant ob.gyn. from the Ikazia Ziekenhuis hospital in Rotterdam, the Netherlands.

"Women told us that they were very surprised that we were asking about fecal incontinence during sex, but that it was a real problem. The women who were incontinent during intercourse and other sexual behavior were very reluctant to engage in sexual activity," Dr. de Leeuw said in an interview.

In a study he presented at the annual meeting of the International Continence Society, Dr. de Leeuw identified 171 women who were surgically treated for obstetric anal sphincter injuries immediately after delivery from 1971 to 1990.

In 1995, these women and 131 controls, who were matched for parity and date of delivery, were mailed a questionnaire that asked about fecal and urinary incontinence. Women who responded were then sent a second similar questionnaire about 10 years later that contained additional questions about sexuality. The median follow-up period was 24 years.

Responses from the first questionnaire showed that the prevalence of anorectal complaints was much higher in the patients who had sphincter injury, compared with controls (40% vs. 15%). Similarly, fecal incontinence, urgency, and soiling were reported by 31%, 26%, and 10% of the patients, respectively, compared with 13%, 6%, and 1% of the controls.

Ten years later, the second questionnaire produced similar responses. Anorectal complaints were reported by 64% of sphincter injury patients, compared with 24% of controls. Fecal incontinence, urgency, and soiling were reported by 56%, 31%, and 15% of sphincter injury patients, respectively, compared with 16%, 12%, and 4% of controls.

Unlike the prevalence of urinary incontinence, which tends to equalize ...