{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:40:17Z","timestamp":1785908417695,"version":"3.56.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2003,10,28]],"date-time":"2003-10-28T00:00:00Z","timestamp":1067299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The reported incidence of anal sphincter injury after first (11\u00b75\u201335\u00b70 per cent) and subsequent (3\u00b74\u201312\u00b71 per cent) vaginal deliveries varies widely. In addition, the reported incidence of associated faecal incontinence ranges from zero to 68\u00b72 per cent. The aim of this study was to perform a meta-analysis of reported incidences of postpartum anal sphincter defect diagnosed by endoanal ultrasonography (EAUS) and associated incidences of faecal incontinence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A Medline search yielded five studies with more than 100 subjects who underwent EAUS after childbirth for evaluation of anal sphincter disruption and who were questioned about symptoms of faecal incontinence, defined as any impairment in flatus and stool control but not including urgency of defaecation. A Bayesian meta-analysis was performed to produce one inference while accounting for potential heterogeneity among the five study populations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Meta-analysis of 717 vaginal deliveries revealed a 26\u00b79 per cent incidence of anal sphincter defect in primiparous women and an 8\u00b75 per cent incidence of new sphincter defects in multiparous women. Overall, 29\u00b77 per cent of anal sphincter defects were symptomatic. Some 3\u00b74 per cent of women experienced postpartum faecal incontinence without an anal sphincter defect. In a Bayesian calculation, the probability of postpartum faecal incontinence due to a sphincter defect was 76\u00b78\u201382\u00b78 per cent.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The incidence of occult anal sphincter disruption following vaginal delivery is much higher than commonly estimated. However, at least two-thirds of occult defects are asymptomatic postpartum. The probability of faecal incontinence associated with an anal sphincter defect was 76\u00b78\u201382\u00b78 per cent.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.4369","type":"journal-article","created":{"date-parts":[[2003,10,30]],"date-time":"2003-10-30T11:16:43Z","timestamp":1067512603000},"page":"1333-1337","source":"Crossref","is-referenced-by-count":204,"title":["Meta-analysis to determine the incidence of obstetric anal sphincter damage"],"prefix":"10.1093","volume":"90","author":[{"given":"M","family":"Oberwalder","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Cleveland Clinic Florida, Weston and Naples, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Connor","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S D","family":"Wexner","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Cleveland Clinic Florida, Weston and Naples, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2003,10,28]]},"reference":[{"key":"2021070911423696900_bib1","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/S0140-6736(94)92213-6","article-title":"Obstetric damage and faecal incontinence","volume":"344","author":"Kamm","year":"1994","journal-title":"Lancet"},{"key":"2021070911423696900_bib2","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1002\/bjs.1800780315","article-title":"Anal endosonography in the investigation of faecal incontinence","volume":"78","author":"Law","year":"1991","journal-title":"Br J Surg"},{"key":"2021070911423696900_bib3","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1136\/bmj.307.6905.636","article-title":"Faecal incontinence","volume":"307","author":"Swash","year":"1993","journal-title":"BMJ"},{"key":"2021070911423696900_bib4","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/S0140-6736(96)91176-9","article-title":"Obstetricians' personal choice and mode of delivery","volume":"347","author":"Al-Mufti","year":"1996","journal-title":"Lancet"},{"key":"2021070911423696900_bib5","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/j.1471-0528.1985.tb03053.x","article-title":"Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology","volume":"92","author":"Snooks","year":"1985","journal-title":"Br J Obstet Gynaecol"},{"key":"2021070911423696900_bib6","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/BF02553877","article-title":"Anorectal complications of vaginal delivery","volume":"32","author":"Venkatesh","year":"1989","journal-title":"Dis Colon Rectum"},{"key":"2021070911423696900_bib7","first-page":"53","article-title":"Anal sphincter function after delivery rupture","volume":"70","author":"Haadem","year":"1987","journal-title":"Obstet Gynecol"},{"key":"2021070911423696900_bib8","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/0002-9378(89)90428-6","article-title":"Association of episiotomy and delivery position with deep perineal laceration during spontaneous delivery in nulliparous women","volume":"160","author":"Borgatta","year":"1989","journal-title":"Am J Obstet Gynecol"},{"key":"2021070911423696900_bib9","first-page":"553","article-title":"Clinical consequences of anal sphincter rupture during vaginal delivery","volume":"183","author":"Fornell","year":"1996","journal-title":"J Am Coll Surg"},{"key":"2021070911423696900_bib10","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1056\/NEJM199312233292601","article-title":"Anal-sphincter disruption during vaginal delivery","volume":"329","author":"Sultan","year":"1993","journal-title":"N Engl J Med"},{"key":"2021070911423696900_bib11","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/BF02235567","article-title":"Are sphincter defects the cause of anal incontinence after vaginal delivery? 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