THE ANAL SPHINCTER

Hypothesis / aims of study Anal incontinence can have a devastating effect on a woman’s quality of life. Obstetric anal sphincter injury (OASI) is the major cause of anal incontinence. Despite primary end-to-end anal sphincter repair, up to 59 % of women suffer anal incontinence and sonographic sphincter defects have been demonstrated in about 85 % of women. In a non-randomised study using the overlap technique better results has been demonstrated1. We aimed to perform a randomised study to determine the outcome of primary repair of OASI comparing the end-to-end to overlap technique. Study design, materials and methods A prospective multicentre randomised controlled study was designed to compare overlap and end-to-end techniques for primary external sphincter repair of OASI. The primary outcome of the study was anal incontinence, which include faecal urgency, faecal urge incontinence, flatus incontinence, liquid and solid faecal incontinence at twelve months. The secondary outcomes were perineal pain, dyspareunia, quality of life, anal sphincter defects detected by endoanal scans and ano-rectal manometry at twelve months. To show any significan