Obstetric anal sphincter injury (OASI) is recognised as the most common cause of anal incontinence (AI) in childbearing-aged women (Marsh 2011), encompassing symptoms of flatus incontinence, passive soiling, incontinence of liquid or solid stool and faecal urgency. These symptoms can cause social and hygienic problems that lead to: isolation, limiting occupational and social activity; negative effect on sexual function and consequent impact on relationships; reduced self-esteem and reduced quality of life(Leigh & Turnberg 1982, Boreham et al 2005, Lo et al 2010, Keighley et al 2016). In the UK approximately 5.9 per cent of women will sustain an OASI, with UK data demonstrating a tripling of incidence over the past decade, possibly because of increased awareness and improved methods of detection (Gurol-Urganci et al 2013). However, it has also been suggested that changes in practice of the use of Manual Perineal Protection (MPP) - from 'hands on [the perineum]' to 'hands off - and a reduction in episiotomies may also have contributed to this rise (Ismail et al 2015). In view of this rising incidence, and Denmark's and Norway's success in reducing their incidence of OASI from just over 4 per cent to just over 1 per cent by introducing interventions including MPP, an OASI Care Bundle was launched across the UK to see if the incidence of such trauma can be reduced (Gurol-Urganci et al 2020, Bidwell et al 2020).
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