Care pathways and anorectal evaluation for obstetric anal sphincter injury-related incontinence: a UK survey of obstetricians
Author(s)
Type
Journal Article
Abstract
Aim
To report on national clinical practice in relation to the post-partum management of patients with obstetric anal sphincter injury (OASI)-related incontinence in the UK.
Method
This was a cross-sectional, observational study of maternity units in the National Health Service (NHS). Data were collected using a survey that was distributed, via the British Society of Urogynaecologists (BSUG), Royal College of Obstetricians & Gynaecologists (RCOG) and the NHS England email directory, to consultant obstetricians and urogynaecologists involved in the post-partum care of patients with OASI. A descriptive, thematic analysis of the data was performed.
Results
One hundred and twenty-six responses were included in the final analysis (estimated response rate~2.5%). The majority of respondents routinely conducted clinical and rectal examinations at the post-partum clinic visit (81.7% and 57.6%, respectively) but they were less likely to use an objective screening tool for incontinence (36.5%). Respondents were more likely to refer patients for anorectal studies if they were symptomatic (72.6%) rather than asymptomatic (34.2%); the diagnostic modality of choice was endoanal ultrasound (70%) rather than manometry (0%). Almost 80% of respondents discharged asymptomatic patients within 3 months. All respondents referred symptomatic patients for physiotherapy; 87% were seen within 6 weeks. Although 70% would discuss complicated cases at a multidisciplinary team meeting (MDT), there was a wide variation in which speciality would follow up the patient.
Conclusion
This study demonstrates variability in clinical practice that does not entirely appear to be evidence driven. A nationally endorsed pathway, embedded within Perinatal Pelvic Health Services, could standardize access to expertise and enable benchmarking. A prospective multicentre audit is recommended to compare maternal functional outcomes in units that use these standardized pathways versus those that do not.
To report on national clinical practice in relation to the post-partum management of patients with obstetric anal sphincter injury (OASI)-related incontinence in the UK.
Method
This was a cross-sectional, observational study of maternity units in the National Health Service (NHS). Data were collected using a survey that was distributed, via the British Society of Urogynaecologists (BSUG), Royal College of Obstetricians & Gynaecologists (RCOG) and the NHS England email directory, to consultant obstetricians and urogynaecologists involved in the post-partum care of patients with OASI. A descriptive, thematic analysis of the data was performed.
Results
One hundred and twenty-six responses were included in the final analysis (estimated response rate~2.5%). The majority of respondents routinely conducted clinical and rectal examinations at the post-partum clinic visit (81.7% and 57.6%, respectively) but they were less likely to use an objective screening tool for incontinence (36.5%). Respondents were more likely to refer patients for anorectal studies if they were symptomatic (72.6%) rather than asymptomatic (34.2%); the diagnostic modality of choice was endoanal ultrasound (70%) rather than manometry (0%). Almost 80% of respondents discharged asymptomatic patients within 3 months. All respondents referred symptomatic patients for physiotherapy; 87% were seen within 6 weeks. Although 70% would discuss complicated cases at a multidisciplinary team meeting (MDT), there was a wide variation in which speciality would follow up the patient.
Conclusion
This study demonstrates variability in clinical practice that does not entirely appear to be evidence driven. A nationally endorsed pathway, embedded within Perinatal Pelvic Health Services, could standardize access to expertise and enable benchmarking. A prospective multicentre audit is recommended to compare maternal functional outcomes in units that use these standardized pathways versus those that do not.
Date Issued
2025-07-01
Date Acceptance
2025-05-26
Citation
Colorectal Disease, 2025, 27 (7)
ISSN
1462-8910
Publisher
Wiley
Journal / Book Title
Colorectal Disease
Volume
27
Issue
7
Copyright Statement
© 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40579392
Subjects
3RD
anorectal function
care pathways
FECAL INCONTINENCE
follow up
Gastroenterology & Hepatology
incontinence
Life Sciences & Biomedicine
MANAGEMENT
obstetric anal sphincter injury
obstetrician
PHYSIOLOGY
referral
RISK
Science & Technology
surgeon
Surgery
TEARS
urogynaecologist
VAGINAL DELIVERY
Publication Status
Published
Coverage Spatial
England
Article Number
e70140
Date Publish Online
2025-06-27