No bulking agents needed after OB anal sphincter injury

A laxative alone is preferable to a laxative plus a stool-bulking agent for women with anal sphincter injury following childbirth, according to a randomized trial.

Researchers in Ireland randomized 147 postpartum women who had undergone primary anal sphincter repair for a third-degree tear to receive either lactulose alone three times daily for the first 3 postpartum days followed by sufficient lactulose to maintain a soft stool for the next 10 days, or the same amount of lactulose combined with a sachet of ispaghula husk daily for the first 10 postpartum days.

While pain scores for the first postpartum bowel movement, time to first bowel movement, length of hospital stay, and overall satisfaction with bowel habits were similar for both groups, almost twice as many women taking the two preparations as those taking just the laxative experienced incontinence during the immediate postnatal period (32.86% vs. 18.18%, respectively, P=0.03). The authors of the study could not find any benefits from taking two agents and recommended that bulking agents be reserved for a minority of women who develop significant postnatal constipation.

Commentary from Sharon Phelan, MD, Professor, Department of Obstetrics and Gynecology, University of New Mexico Health Science Center School of Medicine, Albuquerque, NM.

The use of stool softeners is confirmed to be useful and primarily the main requirement for postpartum care. Keep in mind, however, that the issues of narcotic pain control and content of fiber in the basic diet were not addressed in the study. The key issues continue to be good hygiene of laceration and keeping the stools soft, especially if narcotics are used for pain control.