Management and consequences of obstetrical anal sphincter injuries: Review

•Obstetric Anal Sphincter Injuries (OASI) affect around 0.8% of deliveries in France, or 6000 women per year.•Grades 3 and 4 OASI correspond respectively to lesions of the external and internal anal sphincter (formerly called “incomplete” and “complete” perineal tears).•There are no specific recommendations to prevent OASI during a simple vaginal delivery.•Immediate repair (or within a few hours) is the rule.•The expected complications are imperfect healing (8%), recto-vaginal fistula (3%), dyspareunia or vaginal lubrication disorders (30–50%), and anal incontinence (AI) (the prevalence of which increases over time, up to 60% at 15–25 years after childbirth).•Prevention of long-term complications and initial patient information could be the keys to improving patient quality of life. Obstetrical anal sphincter injuries (OASI), formerly referred to as “complete” or “incomplete” perineal tears, are a frequent complication of childbirth. They can lead to intestinal consequences (anal incontinence, ano-genital fistula) or sexual consequences (dyspareunia, genital pain). The complexity of management of OASI lies in the multi-factorial nature of these consequences but also in the frequently lengthy interval before their appearance, often long after childbirth. Indeed, while 2.4% of women in childbirth develop OASI, up to 61% of them will present with anal incontinence15 to 25 years after childbirth. Immediate or delayed repair of the sphincter and perineum within a few hours of injury is therefore the rule, but there is no consensus on longer-term management. The patient must be educated on preventive actions (avoidance of pushing or straining, regularization of stool transit, muscle strengthening, etc.). Early detection of anal incontinence leads to prompt management, which is more effective. This review aims to synthesize the information necessary to provide clear and up-to-date patient information on OASI (risk factors and prevalence), the management of OASI, and the management of eventual complications in the setting of dedicated specialty consultations. Dedicated “post-OASI” consultations by a specialist in ano-perineal pathologies could therefore become a first step in the development of care for women, particularly by removing the “shameful” nature of the symptoms.