Obstetric anal sphincter injuries (OASIs) refer to injuries to the anal sphincter muscles and surrounding tissues that can occur during childbirth. These injuries, particularly third- and fourth-degree perineal tears, are significant because they can lead to long-term complications such as bowel and bladder incontinence, sexual dysfunction, and chronic pelvic pain. Early diagnosis and treatment are crucial to prevent long-term problems.

The aim of this workshop is to emphasize on the importance of a multidisciplinary approach (assess, diagnose and treat) in managing women with OASI sustained during childbirth, addressing both the immediate management of the injury and long-term management of any complications or recovery challenges.

Learning Objectives

• Understanding Obstetric Anal Sphincter Injury (OASI) • Definition and Classification: Understand the different degrees of obstetric anal sphincter injuries (OASI), including 3rd-degree (involving the anal sphincter) and 4th-degree (involving the anal sphincter and rectal mucosa) tears. • Etiology: Learn about the risk factors and causes of OASI, including instrumental delivery, prolonged second stage of labor, large fetal size, and perineal trauma. • Diagnosis: Understand the clinical signs and diagnostic methods for OASI, including examination, perineal ultrasound, and anorectal manometry. Management of Anal Incontinence • Assessment of Anal Function: Learn to assess anal sphincter function using clinical evaluation, anorectal manometry, endoanal ultrasound, and other diagnostic tools. • Treatment Options: Understand the treatment modalities for anal incontinence, including conservative management (e.g., pelvic floor exercises, dietary changes), medical treatments
• Perioperative Care and Surgical Management • Surgical Repair: Learn the principles and techniques for repairing third- and fourth-degree perineal tears, including the importance of proper alignment and anatomical restoration. • Postoperative Care: Gain knowledge about post-repair care, such as analgesia, wound care, prevention of infection, and early mobilization. • Complication Management: Be able to recognize and manage potential complications like wound breakdown, infection, and failure of repair (e.g., anal incontinence or recurrent sphincter damage). • Long-Term Follow-Up: Recognize the need for long-term follow-up to monitor recovery and the potential for ongoing or worsening symptoms of anal incontinence. Psychosocial Impact • Psychological Support: Be able to address the psychological impact of OASI, which may include anxiety, depression, sexual dysfunction, and reduced quality of life. • Patient Education and Communication: Develop skills in discussing sensitive topics with patients, including the physical and emotional effects of OASI, treatment options, and prognosis. • Supportive Care: Provide referrals to mental health professionals, pelvic floor physiotherapists, and other support services to help women cope with the long-term impacts of OASI.
• Multidisciplinary Teamwork • Collaboration with Specialists: Understand the roles of different healthcare providers in the management of OASI, including obstetricians, colorectal surgeons, physiotherapists, Clinical Scientists and psychologists. • Coordinating Care: Learn how to coordinate care between different specialists for comprehensive management, including follow-up care after childbirth and ongoing treatment for anal incontinence.