A Multidisciplinary Approach to Obstetric Anal Sphincter Injury (OASI)

Workshop Schedule

13:00

Linda Ferrari

13:15

Linda Ferrari

13:30

Paula Igualada Martinez

13:50

Carlo Ratto

14:00

Alexis M P Schizas

14:20

All

Aims & Objectives

Intermediate
90 minutes
Pregnancy and Pelvic Floor Disorders
Clinical
Obstetric anal sphincter injury pelvic floor dysfunction Multidisciplinary approach
Urology, Urogynaecology and Female & Functional Urology, Bowel Dysfunction, Pure and Applied Science, Conservative Management

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.

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