{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:53:11Z","timestamp":1791946391840,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Obstetric anal sphincter injury (OASI) is associated with long\u2010term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth\u2010degree tear more likely to cause AI over a third\u2010degree tear?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross\u2010sectional and case\u2010control studies without language restrictions. The quality was assessed by the Newcastle\u2010Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross\u2010sectional studies. Length of follow\u2010up ranged from 1\u2009month to 23 years, with the majority of the reports (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916) analysing data within 12\u2010months postpartum. Third\u2010degree tears evaluated were 6454 versus 764 fourth\u2010degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two\u2010 to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth\u2010degree tears, but this failed to reach statistical significance. Cross\u2010sectional studies with long\u2010term (\u22655 years) follow\u2010up showed that women with fourth\u2010degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow\u2010up was significantly shorter (\u22641 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth\u2010degree tear and FI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long\u2010term follow\u2010up should be performed to evaluate the risk of AI for each OASI subtype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.25235","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T01:45:30Z","timestamp":1689039930000},"page":"1455-1469","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9381-7375","authenticated-orcid":false,"given":"Martino Maria","family":"Zacch\u00e8","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Birmingham Women's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayasish","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Walsall Manor Hospital Walsall UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Liapis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Birmingham Women's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chioma","family":"Chilaka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Birmingham Women's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pallavi","family":"Latthe","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Birmingham Women's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Toozs\u2010Hobson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Birmingham Women's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01502.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.10.796"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22922"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.18315"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32002-6"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12363"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/135626229900500601"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2010.01037.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0901-2"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04405-2"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-04108-3"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.08.026"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7512"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3334-3"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00647.x"},{"key":"e_1_2_11_17_1","unstructured":"RCOG. 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