January marks Obstetric Anal Sphincter Injuries (OASIs) Awareness Month, a time to raise awareness about a crucial yet often overlooked aspect of maternal health.
Join us in promoting understanding, prevention, and support for those affected by OASIs. Together, let’s foster a community that prioritizes the well-being of mothers and advocates for comprehensive healthcare!
What are Obstetric Anal Sphincter Injuries (OASIs)?
An OASI (third or fourth-degree tear) is an anal sphincter tear that involves the muscles surrounding the anal canal that can occur during vaginal birth. It occurs in 3% of all births but 6% of first vaginal births.
The anal sphincter controls the timely release of stool and wind, thereby maintaining continence. Unfortunately, OASI is the most common cause of anal incontinence in women worldwide, which can significantly impact a woman’s quality of life. Symptoms of anal incontinence include the sudden urge to open one’s bowels, inability to control passing wind, or leakage of stool. If women following OASI report these symptoms or have concerns they have had an OASI as they are symptomatic, they should be signposted to an appropriate health care professional with an interest in this area, including physiotherapy.
So, how can we reduce the rate of OASIs?
Although recognition and appropriate repair of an OASI is of paramount importance (you can visit www.perineum.net for training opportunities), prevention is always better than cure.
OASI rates can be reduced when the following are used in combination as part of the RCOG OASIs care bundle:
- Adequate information about OASIs is provided for women antenatally.
- Manual perineal protection is performed during birth.
- A mediolateral episiotomy is performed when required.
- An examination of the vagina and rectum is performed after birth to diagnose OASIs.
Unfortunately, anal ultrasound has shown that healthcare professionals (in low and high-resource countries) lack adequate training; IUGA has promoted the PROTECT Program, whereby doctors are trained and certified to become IUGA-approved trainers globally after hands-on training and evidence-based surgical repairs. We are grateful to these trainers who have made a dramatic impact in training and disseminating knowledge worldwide.
We have indeed come a long way to minimize OASIs and their consequences, but there is still much to do to overcome childbirth-related anal incontinence, the most degrading benign condition for any human being to endure.
On behalf of:
The Pelvic Floor and OASIs Special Interest Group
Abdul H. Sultan MD (Res), FRCOG (Chair)
N. Adanna Okeahialam MD (Res) MRCOG (Committee member)
Want to learn more about your pelvic floor health? There are hundreds of free resources on 40+ topics in 25+ languages at www.YourPelvicFloor.org.
IUGA offers the PROTECT Program (PROTECT: Prevention and Repair Of perineal Trauma Episiotomy through Coordinated Training), a “train the trainer” program, with the main goal being to promote knowledge of obstetricians and midwives globally in the management of OASIs.
Interested in learning more about OASIs and how to provide better advice to your patients? A SIG Session on Pelvic Floor and Obstetric Anal Sphincter Injuries - Management Dilemmas in OASIs will take place on Saturday, January 27, 2024, at 11:00 AM UTC. Unable to attend? Stay tuned, as it will be available on-demand in the IUGA Video Library!*
The International Symposium on Global Health, scheduled to take place virtually on February 3-4, will also address topics related to OASIs. Register today to secure your spot for two informative and interactive days and continue your professional development.
Streaming on-demand videos is an IUGA member benefit. Not a member yet? Join us today!