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Anal sphincter injury

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https://www.readbyqxmd.com/read/29155140/pregnancy-and-parturition-negatively-impact-vaginal-angle-and-alters-expression-of-vaginal-mmp-9
#1
Sallie Oliphant, Timothy Canavan, Stacy Palcsey, Leslie Meyn, Pamela Moalli
BACKGROUND: Parity is the greatest risk factor for the development of pelvic organ prolapse. The normally supported vagina is pulled up and back over the levator ani. Loss of vaginal angulation has been associated with prolapse and may represent injury to the vaginal supportive tissues. OBJECTIVE: We propose that 1) pregnancy and delivery impact support to the vagina leading to loss of vaginal angle; 2) vaginal angulation is restored postpartum; and 3) uncomplicated vaginal delivery (VD) is associated with accelerated remodeling of the vaginal fibrillar matrix...
November 16, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29155037/long-term-anal-incontinence-after-obstetric-anal-sphincter-injury-does-grade-of-tear-matter
#2
Hanna Jangö, Jens Langhoff-Roos, Susanne Rosthøj, Abelone Sakse
BACKGROUND: Anal incontinence is a major concern following delivery with obstetric anal sphincter injury and has been related to the degree of sphincter tear. OBJECTIVES: To 1) evaluate whether women with a fourth degree obstetric anal sphincter injury in the first delivery have an increased risk of long-term anal- and fecal incontinence after a second delivery and 2) assess the impact of mode of second delivery on anal incontinence and related symptoms in these patients...
November 15, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29139310/pudendal-nerve-injury-impairs-anorectal-function-and-health-related-quality-of-life-measures-%C3%A2-2-years-after-3d-conformal-radiotherapy-for-prostate-cancer
#3
Eng Eric Yeoh, Rochelle Botten, Addolorata Di Matteo, Marcus Tippett, Jonathon Hutton, Robert Fraser, Phillip G Dinning, David Wattchow
PURPOSE: To compare GI symptoms, measures of generic and disease specific health related quality of life (HRQoL), anorectal and pudendal nerve function and anal sphincter morphology between (i) patients ≥2 years after 3D conformal radiotherapy (3D-CRT)±high dose rate (HDR) brachytherapy for carcinoma of the prostate and aged matched patients before radiotherapy and (ii) symptomatic and asymptomatic patients ≥2 years after 3D-CRT ± HDR brachytherapy. MATERIAL AND METHODS: Methodology included: (i) modified LENT-SOMA scales for GI symptoms, (ii) EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires for generic and disease specific HRQoL, (iii) anorectal manometry and terminal motor latency for anorectal and pudendal nerve function and (iv) endorectal ultrasound for anal sphincter morphology...
November 15, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/29117015/racial-ethnic-differences-in-perineal-lacerations-in-a-diverse-urban-healthcare-system
#4
Amanda Williams, Beverly Gonzalez, Colleen Fitzgerald, Cynthia Brincat
OBJECTIVES: The aim of the study was o determine whether variations exist between races/ethnicities in perineal laceration at first vaginal delivery. METHODS: We assessed first vaginal deliveries greater than 35 weeks gestation, for a four-year period, in our diverse urban healthcare system. Predictor variable was race/ethnicity with outcome variable of none, first-, second-, third-, or fourth-degree perineal laceration. Race and ethnicity were self-reported and combined into one variable to facilitate analysis...
November 7, 2017: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/29112569/stromal-cell-derived-factor-1-plasmid-regenerates-both-smooth-and-skeletal-muscle-after-anal-sphincter-injury-in-the-long-term
#5
Li Sun, Mei Kuang, Marc Penn, Margot S Damaser, Massarat Zutshi
BACKGROUND: Regenerating muscle at a time remote from injury requires re-expression of cytokines to attract stem cells to start and sustain the process of repair. OBJECTIVE: We aimed to evaluate the sustainability of muscle regeneration after treatment with a nonviral plasmid expressing stromal cell-derived factor 1. DESIGN: This was a randomized study. SETTINGS: The study was conducted with animals in a single research facility...
December 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29046273/upright-versus-lying-down-position-in-second-stage-of-labour-in-nulliparous-women-with-low-dose-epidural-bumpes-randomised-controlled-trial
#6
RANDOMIZED CONTROLLED TRIAL
(no author information available yet)
Objective To determine whether being upright in the second stage of labour in nulliparous women with a low dose epidural increases the chance of spontaneous vaginal birth compared with lying down.Design Multicentre pragmatic individually randomised controlled trial.Setting 41 UK hospital labour wards.Participants 3093 nulliparous women aged 16 or older, at term with a singleton cephalic presentation and in the second stage of labour with epidural analgesia.Interventions Women were allocated to an upright or lying down position, using a secure web based randomisation service, stratified by centre, with no masking of participants or clinicians to the trial interventions...
October 18, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29022787/does-a-missed-obstetric-anal-sphincter-injury-at-time-of-delivery-affect-short-term-functional-outcome
#7
L Ramage, C Yen, S Qiu, C Simillis, C Kontovounisios, E Tan, P Tekkis
Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment...
September 15, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/28988909/detailed-muscular-structure-and-neural-control-anatomy-of%C3%A2-the-levator-ani-muscle-a-study-based-on-female-human%C3%A2-fetuses
#8
Krystel Nyangoh Timoh, David Moszkowicz, Mazen Zaitouna, Cedric Lebacle, Jelena Martinovic, Djibril Diallo, Maud Creze, Vincent Lavoue, Emile Darai, Gérard Benoit, Thomas Bessede
BACKGROUND: Injury to the levator ani muscle or pelvic nerves during pregnancy and vaginal delivery is responsible for pelvic floor dysfunction. OBJECTIVE: We sought to demonstrate the presence of smooth muscular cell areas within the levator ani muscle and describe their localization and innervation. STUDY DESIGN: Five female human fetuses were studied after approval from the French Biomedicine Agency. Specimens were serially sectioned and stained by Masson trichrome and immunostained for striated and smooth muscle, as well as for somatic, adrenergic, cholinergic, and nitriergic nerve fibers...
October 6, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28969732/delayed-reconstruction-of-a-traumatic-cloaca-following-obstetric-anal-sphincter-rupture
#9
Ali Ezer, Alper Parlakgumus
Permanent communication between the rectum and the vagina along with full thickness of anal sphincter faults can be a result of an unsuccessful primary repair of fourth degree obstetric trauma. This results into complete fecal incontinence and impaired quality of life. Anterior overlapping sphincteroplasty can be chosen as a method of treatment for fecal incontinence due to obstetric injuries. However, large perineal body reconstructions are generally pretty challenging tasks for surgeons. What we will describe here for the repair of a traumatic cloaca, occurred 23 years ago during vaginal delivery, is the use of a transpositional flap following overlapping sphincteroplasty...
September 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28929282/anoperineal-lesions-in-crohn-s-disease-french-recommendations-for-clinical-practice
#10
REVIEW
D Bouchard, L Abramowitz, G Bouguen, C Brochard, A Dabadie, V de Parades, M Eléouet-Kaplan, N Fathallah, J-L Faucheron, L Maggiori, Y Panis, F Pigot, P Rouméguère, A Sénéjoux, L Siproudhis, G Staumont, J-M Suduca, B Vinson-Bonnet, J-D Zeitoun
BACKGROUND: Anoperineal lesion (APL) occurrence is a significant event in the evolution of Crohn's disease (CD). Management should involve a multidisciplinary approach combining the knowledge of the gastroenterologist, the colorectal surgeon and the radiologist who have appropriate experience in this area. Given the low level of evidence of available medical and surgical strategies, the aim of this work was to establish a French expert consensus on management of anal Crohn's disease. These recommendations were led under the aegis of the Société Nationale Française de Colo-Proctologie (SNFCP)...
September 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28915858/risk-of-obstetric-anal-sphincter-injury-increases-with-maternal-age-irrespective-of-parity-a-population-based-register-study
#11
Ulla Waldenström, Cecilia Ekéus
BACKGROUND: Obstetric anal sphincter injury (OASI) is a rare but serious outcome of vaginal birth. Based on concerns about the increasing number of women who commence childbearing later than previous generation, this study aimed at investigating age-related risk of OASI in women of different parity. METHODS: A population-based register study including 959,559 live singleton vaginal births recorded in the Swedish Medical Birth Register 1999 to 2011. In each parity group risks of OASI at age 25-29 years, 30-34 years, and ≥35 years compared with age < 25 years were investigated by logistic regression analyses, adjusted for year of birth, education, region of birth, smoking, Body Mass Index, infant birthweight and fetal presentation; and in parous women, history of OASI and cesarean section...
September 15, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28914706/long-term-sexual-function-after-obstetric-anal-sphincter-injuries
#12
Michele S OʼShea, Christina Lewicky-Gaupp, Dana R Gossett
OBJECTIVES: Obstetric anal sphincter injuries (OASIS) are associated with severe short and long-term morbidities, although little is known about the long-term sexual function or satisfaction of women and partners of women with history of OASIS. The objective of this study was to describe the long-term sexual function and satisfaction of women who previously sustained OASIS and to assess sexual satisfaction among their male partners. METHODS: This was a follow-up study of participants enrolled in the For Optimal Recovery: Care After Severe Tears (FORCAST) prospective cohort study of women with a history of OASIS after delivery of a full-term singleton infant between 2011 and 2013...
September 13, 2017: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/28913133/the-relationship-between-fecal-incontinence-and-vaginal-delivery-in-the-postmenopausal-stage
#13
Süleyman Kargın, Sami Çifçi, Adnan Kaynak, Hüseyin Ataseven, Cengiz Kadıyoran, Murat Çakır
OBJECTIVE: Obstetric anal sphincter injuries are one of the most significant complications of vaginal delivery that give way to fecal incontinence, which is defined as the involuntary leakage of gas, fluid or solid stool. Although sphincter injuries are seen in 0.5-9% of all deliveries. It has been reported that 20-41% of women who had vaginal deliveries had occult anal sphincter injuries as endoanal ultrasonography began to be used by physicians. The aim of our study was to investigate the relationship between fecal incontinence, whose incidence increases dramatically during the postmenopausal stage, and occult anal sphincter injuries...
March 2017: Turk J Obstet Gynecol
https://www.readbyqxmd.com/read/28901946/design-of-semg-assembly-to-detect-external-anal-sphincter-activity-a-proof-of-concept
#14
Arsam Shiraz, Brian Leaker, Charles Alexander Mosse, Eskinder Solomon, Michael Craggs, Andreas Demosthenous
OBJECTIVE: Conditional trans-rectal stimulation of the pudendal nerve could provide a viable solution to treat hyperreflexive bladder in spinal cord injury. A set threshold of the amplitude estimate of the external anal sphincter surface electromyography (sEMG) may be used as the trigger signal. The efficacy of such a device should be tested in a large scale clinical trial. As such, a probe should remain in situ for several hours while patients attend to their daily routine; the recording electrodes should be designed to be large enough to maintain good contact while observing design constraints...
October 31, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28885403/postpartum-management-after-obstetric-anal-sphincter-injuries
#15
Allison Eubanks, Scott M Petersen
A 26-year-old woman, gravida 1 para 1, experiences a severe perineal laceration that extends through the rectal mucosa after a vaginal delivery. She asks you, "What can be done to optimize my recovery?"
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28884835/non-invasive-electromyographic-estimation-of-motor-unit-number-in-the-external-anal-sphincter-of-the-rat
#16
Chuan Zhang, Alvaro Munoz, H Henry Lai, Timothy Boone, Yingchun Zhang
AIMS: The external anal sphincter (EAS) is essential for maintaining fecal continence. Neurological disorders or traumatic injuries to muscle and nervous systems could lead to EAS denervation. Currently, there are no techniques available to document global innervation changes in the EAS in vivo. The aim of this study was to develop a novel approach to non-invasively estimate the number of functioning motor units (MUs) in the EAS and validate with immunofluorescent techniques in rats. METHODS: Intra-rectal surface electromyography (EMG) signals of the EAS, induced by a series of intra-vaginally delivered pudendal nerve stimulations with different intensities, were recorded...
September 8, 2017: Neurourology and Urodynamics
https://www.readbyqxmd.com/read/28838787/surgical-interventions-and-the-use-of-device-aided-therapy-for-the-treatment-of-fecal-incontinence-and-defecatory-disorders
#17
Adil E Bharucha, Satish S C Rao, Andrea S Shin
The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best Practice Advice 1: A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first...
December 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28818731/association-between-severities-of-striae-gravidarum-and-obstetric-anal-sphincter-injuries-oasis
#18
Ofra Halperin, Anita Noble, Shosh Balachsan, Ester Klug, Michal Liebergall-Wischnitzer
OBJECTIVES: to examine the association between the severities of Striae Gravidarum (SG) and Obstetric Anal Sphincter Injuries (OASIS) and to measure the symptoms regarding urinary incontinence, fecal/flatus incontinence, and dyspareunia, at 6 and 12 months postpartum. DESIGN: this is a cohort study. SETTING: four university teaching medical centers in Israel, two in the north and two in the center of the country. PARTICIPANTS: women with OASIS were interviewed and assessed for SG...
November 2017: Midwifery
https://www.readbyqxmd.com/read/28782264/anal-sphincter-defects-and-faecal-incontinence-15-24-years-after-first-delivery-a-cross-sectional-study
#19
Rodrigo A Guzmán Rojas, Kjell Å Salvesen, Ingrid Volløyhaug
OBJECTIVES: To establish the prevalence of external (EAS) and internal anal sphincter (IAS) defects 15-24 years after childbirth in association to mode of delivery and faecal incontinence (FI), and compare the proportion of obstetric anal sphincter injuries (OASIS) reported at delivery with defects on ultrasound. METHODS: This was a cross-sectional study including 563 women, who delivered their first child from 1990-97. Women responded to a validated questionnaire (PFDI) in 2013-14...
August 6, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28776641/the-great-divide-country-of-birth-as-a-risk-factor-for-obstetric-anal-sphincter-injuries
#20
James Brown, Supuni Kapurubandara, Emma Gibbs, Jennifer King
BACKGROUND: Obstetric anal sphincter injuries (OASIS) can complicate up to 6% of births and are a major contributor to preventable maternal morbidity. Asian women have a risk of third and fourth degree perineal tears up to four times greater than women of other ethnicities in the same community, but the lack of differentiation of Asian women into regional groups has limited insight into the reasons behind their increased risk. AIMS: To investigate risk of OASIS associated with country of birth...
August 4, 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
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