What is Anal Sphincter Injury in Childbirth and what are its consequences for the mother?

An anal sphincter (AS) injury affects many first-time mothers who give birth vaginally. Over 10% of mothers having a baby through the birth canal can develop some form of anal incontinence (AI).The risk is even higher when having a first baby.

This can present itself as inability to hold flatus (wind) or stool (faeces). There may be urgency issues and associated anxiety.

Mothers rarely volunteer information about their injury because of the embarrassment and associated social stigma. They often suffer in silence and are very alone.

Depression, Anxiety and a multitude of psychological effects may also impact heavily on a woman with an AS injury.

This condition not only affects the woman but has a ripple effect that can damage family relations, bonding and physical contact not only with the partner but also with the child. Isolation, degradation and irritability are at the forefront of women with AI.

Why do we need the MASIC Foundation?

We need a new charity to help these mothers. Our objectives are five-fold:

      1. Campaigning to influence changes in healthcare policies to avoid these injuries and improve their detection;
      2. Promoting awareness in the medical and healthcare professionals. Today’s doctors have little exposure to obstetric practice. General Practitioners, Midwives and Health Visitors are largely unaware of the frequency and long term consequences of MASIC;
      3. Advancing awareness. The public are unaware that over 10% of mothers have some impairment of bowel control after birth;
      4. Promotion of research into the causes, prevention and treatment of MASIC;

But Above All Else

5. Supporting mothers who have sustained these injuries and their families.

The MASIC Foundation: A Plan for the First Three Years

1. Support for Mothers

We aim to roll out a Care Pathway, through the web, social media and the printed word, so that those with symptoms know where to go. In doing so, we will promote counselling, education, a multidisciplinary team approach, a nurse-led coping strategy, dietary advice, biofeedback and pelvic floor retraining, group support, psychological advice, urogenital therapy, neuromodulation, treatment of the psychiatric sequelae and surgical repair.

2. Public Awareness

We aim to develop public awareness of MASIC (Mothers with Anal Sphincter Injuries in Childbirth), through the web, media soundbites and a publicity campaign. This will be reinforced by stories from Focus Groups, stressing the early identification of women who have been injured, use of the Care Pathway and showcasing research in progress.

3. Health Education

We need to change attitudes and practice. We will campaign to avoid these injuries and promote their detection and repair at birth. We will disseminate a care pathway for mothers with the condition. This will require a dialogue with NHS England and equivalent Scottish, Welsh and Republic of Ireland structures. This will also focus on better continence care and training, supervision and mentoring of midwives. We shall campaign at a national level but disseminate regionally working with appropriate Medical Royal Colleges, the British Medical Association and their equivalents in the Republic of Ireland.

4. Professional Awareness: Education

We will roll out a multi-disciplinary educational programme for Midwives, Health Visitors, General Practitioners, Obstetricians and Gynaecologists, Psychiatrists Sexual Health Practitioners, Colorectal Nurses, Urogynaecologists, Physiotherapists, Physiologists and Counsellors. Professional awareness will focus on an understanding of: risk factors, psychological sequelae, avoidable injury, immediate detection and repair at birth, early identification and treatment of mothers with symptoms, counselling for the husband/partner, developing self-help strategies and new technologies for treatment.

5. Research

We plan to support research into

  • Methods of prevention
  • Early detection
  • Feasibility of a National Information Card so that mothers who may have AI can be told how they can access an assessment and help.
  • To de-stigmatise the consequences via the Care Pathway, through Primary Care, The Bowel Disease Research Foundation (BDRF), The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.
  • Support groups at a local level.

We shall develop a regional structure in the UK and Ireland to promote our care pathway, educational policies and research.