Anal incontinence : management improvements – Management of obstetrical anal sphincter injuries
Seance of wednesday 14 may 2025 (Chirurgie proctologique)
DOI number : 10.26299/6hh8-db12/2025.18.02
Abstract
Anal incontinence (AI) is a major but underestimated public health burden. It affects 1 to 20% of the general population with a significant increase with age. The majority of clinical studies report the management of patients over 60 years old while this symptom also affects young subjects.
In a recent online survey of individuals under 65, 36.6% of respondents reported an AI (n=176). Recently, an analysis of the PMSI showed an increase in AI around 40 years old in women, probably related to previous births (traumatic or not).
It is also found that despite this and despite an impairment of the quality of life relative to AI, women do not seek care (unlike urinary incontinence). One of the strategic developments in management is therefore primary prevention (to limit the risks of obstetric lesions of the anal sphincter) and secondary, particularly through improved information on AI risks and the possibilities of management during dedicated consultations. Earlier management of AI enables the implementation of treatments, surgical or not, effective in young subjects and which could delay or limit the use of neuromodulation of sacred nerve roots whose long-term effectiveness seems to be exhausted.
Efforts are certainly needed to improve communication with the general public about this shameful but particularly embarrassing symptom.
In a recent online survey of individuals under 65, 36.6% of respondents reported an AI (n=176). Recently, an analysis of the PMSI showed an increase in AI around 40 years old in women, probably related to previous births (traumatic or not).
It is also found that despite this and despite an impairment of the quality of life relative to AI, women do not seek care (unlike urinary incontinence). One of the strategic developments in management is therefore primary prevention (to limit the risks of obstetric lesions of the anal sphincter) and secondary, particularly through improved information on AI risks and the possibilities of management during dedicated consultations. Earlier management of AI enables the implementation of treatments, surgical or not, effective in young subjects and which could delay or limit the use of neuromodulation of sacred nerve roots whose long-term effectiveness seems to be exhausted.
Efforts are certainly needed to improve communication with the general public about this shameful but particularly embarrassing symptom.