Евалвација на појавата на анална инконтиненција по вагинално породување, ризик-фактори и влијание врз квалитетот на животот

Abstract

Introduction: Anal incontinence (AI) is an inconvenient and limiting medical condition that can cause social and hygienic problems, isolation, low self-esteem and low quality of life. The etiology is multifactorial. Women are eight times more affected than men and the reason is considered to be childbirth. In order to prevent this social, physical and psychological problem, it is necessary to define the risk factors leading to development of such symptoms in female patients after undergoing vaginal delivery. Factors that influence occurrence of anal incontinence in patients after vaginal delivery, have been categorized into obstetric, maternal and fetal factors. Aim: The aim of this study is to determine the impact of individual obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery, and its impact on quality of life. Methods: We designed the study as a cross-sectional, and developed the research at the University Clinic for Obstetrics and Gynecology, University of “Ss. Cyril and Methodius” in Skopje, Macedonia, over a period of one year. In this study, we engaged patients in their reproductive age, who had undergone at least one vaginal delivery (spontaneous or assisted vaginal delivery). The degree of incontinence was determined using St. Mark’s Anal Incontinence Score (SMIS). We used a specific questionnaire related to anal incontinence to assess quality of life Fecal Incontinence Quality of Life Scale (FIQLS) Results: Four hundred and seventy (470) patients were included in the study, 30% of which (141 patients) had St. Mark’s scores ≥8. The following factors were found to influence the St. Mark’s score: number of vaginal deliveries, delivery mode, fetal macrosomia, use of episiotomy and the existence of perineal lacerations Conclusion: Results of this study show consistency with data published so far on the influence of obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery. Changes in anal continence are expressed in increased St. Mark’s score. Our study showed that the following factors had statistically significant impact on the score value: multi-parity, delivery mode, use of episiotomy, fetal macrosomia and perineal injury (grades 3 and 4).