None listed
Conditions
Brief summary
Obstetric anal sphincter injury syndrome (OASIS) is a common occurrence in females after childbirth, and is an established risk factor for faecal incontinence (FI). Risk factors for OASIS include increased maternal age, high birth-weight and co-morbidities such as diabetes. As each of these elements is on the rise, the likelihood is that the frequency of OASIS will increase, and along with it, the possible increased burden FI. However, its association with the development of FI remains poorly understood and the obstetrics recommendation following OASIS (C-section vs vaginal delivery) on subsequent pregnancies is highly variable and debated in the literature. We aim to assess the anorectal physiology effect of OASIS, as well as its impact on the patient (Sexual health, quality of life, urinary and faecal incontinence) to first obtain a better understanding of OASIS. We will then compare the data of patients who develop FI (symptomatic) to those who do not (asymptomatic) in an effort to better understand OASIS and its link to FI. Lastly, we aim to collect long term follow up data on patients in order to assess for the subsequent development of FI and other pelvic floor problems. This will enable us to build a prediction model to assist in clarifying the obstetrician’s practice and recommendations for future pregnancies in women with OASIS and/or FI.
Interventions
All participants will be asked to complete a follow up questionnaire.
Anorectal manometry and anorectal ultrasound is to be performed on patient who are consenting to a repeat study using our standard protocol.
(1) Anorectal manometry. This involves insertion of a thin catheter into your rectum (back passage) while you are lying on your left side on a bed. Pressure measurements are then obtained while you squeeze your anal muscles, while you cough and when you bear down or strain. In addition,
All participants will be asked to complete a follow up questionnaire. Anorectal manometry and anorectal ultrasound is to be performed on patient who are consenting to a repeat study using our standard protocol. (1) Anorectal manometry. This involves insertion of a thin catheter into your rectum (back passage) while you are lying on your left side on a bed. Pressure measurements are then obtained while you squeeze your anal muscles, while you cough and when you bear down or strain. In addition, a small balloon will be inflated inside your rectum and you will be asked to rate the sensations felt at that time. Lastly, you will be requested to try to expel the balloon over a private toilet and (2) Anorectal ultrasound. This involves insertion of an anorectal ultrasound probe into your rectum (back passage) while you are lying on your left side on a bed. Imaging is obtained assessing for your anal sphincters. Both procedures are performed by a physician or a nurse specialist and will be done discretely and with consideration for your privacy at all times. The procedures can cause minor discomfort, but this will be minimised by careful technique. Overall the appointment time is approximately 60 minutes. The patients invited to participate in this study have previously attended our neurogastroenterology unit for testing between 2001 and 2015. Our follow-up data will consequently offer a follow-up period between 1-15 years. For ARM testing, the testing protocol is identical to the testing protocol the patients have previously undergone in our Unit. For the anorectal ultrasound, as not all patients have performed this study previously in our Unit, our protocol might be slightly different then the procedure they had previously undergone. Nevertheless, the protocol follows international standards and should be much similiar.
Sponsors
Dr Allison Malcolm
Eligibility
Sex/Gender
All
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
Post-partum females referred to the Neurogastroenterology Unit for anorectal manometry between 1.1.2001 and 1.1.2016
Exclusion criteria
The only exclusion criterion for the study includes patients with a history of psychological illness or condition such as to interfere with the patient’s ability to understand the requirements of the study. Only for patients who agree to undergo repeat physiological testing, exclusion criteria include: 1. Women lactating or pregnant. 2. Patients with significant anorectal disease precluding the insertion of an anorectal tube or ultrasound probe. 3. Latex allergy
Outcome results
None listed