Economic burden and quality of life effect of OASIS on a woman’s life
Research type
Research Study
Full title
Economic burden and quality of life effect of OASIS on a woman’s life
IRAS ID
277783
Contact name
Alessandra Orlando
Contact email
Sponsor organisation
London North West University Healthcare NHS Trust
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Summary of Research
During childbirth, an injury to the anal sphincters (the muscles that control stool and wind from the anus) can lead to a condition called faecal incontinence (the loss of stool or gas from the anus that is out of our control). From previous published study : incontinence is considered worse than death among patients with serious illness and undoubtedly has massive impact on the woman’s life, with long-lasting and eventually permanent damage which results in a life-changing condition for many women. The impact of incontinence could, not only affect the quality of life but also having an economic impact on the life of most women. Most of the studies looking at quality of life after anal sphincter injury at childbirth focus on the impact of FI (faecal incontinence) in terms of shame, embarrassment and feelings of isolation. More insight should be given to the changes these women have to undergo in their everyday-life to accommodate to this condition. This study aims to bring evidence of the changes a woman needs to undergo; it appears to be a concomitant lack of awareness of the difficulties encountered post childbirth by these women in the midwifery and obstetrician community.
This project will work towards the design of another studies to look into the consent process for instrumental delivery (use of forceps or ventouse) in the antenatal period in terms of the amount of information provided to pregnant women about possible risks and complication associated with the use of instruments at childbirth and evaluating alternatives to instrumental delivery.Summary of Results
26 ladies who had OASIS (obstetric anal sphincter anal injuries) which is a high degree tear at childbirth (involving the anal sphincter) and with symptoms of incontinence to gas and / or stools filled 4 questionnaires.As a result of the tear : 46% had to change their career plans, 25% had a decrease in their annual income (average £ 10,000 pa). No changes in career plans or income for their partner was reported. 25% took more maternity leave (7.3 +/- 5.7 months) than planned. 42% had to make changes to their working conditions (such as unable to seek work, take extended leave or moved from full to part time). 17% had to change job. One lady had to leave her job because the toilets were not enough close to her workstation, another lady left her job because too embarrassed by her flatus incontinence.
From the economic point of view : there is a significant impact on the current and future employment status of those affected by faecal incontinence following an OASIS.From the qualitative analysis of the answers to open ended questions on the impact of OASI in their life, themes such struggle, inability, defeat, fear, embarrassment, isolation as a result of symptoms related to the tear were all reported. Other psychological effects were those of anger towards their healthcare professionals, embarrassment with the general public, feelings of guilt and irremediable changes and PTSD. Feelings of having been “let down, rushed, not listened , abandoned” by the healthcare providers after the tear happened were reported. There was a lack of trust with their healthcare providers, due to poor communication before, during and after delivery. Physical symptoms such as pain on standing or while carrying the baby may limit the bonding between mother and baby. Analysis of EQ-5D-5L questionnaire (a questionnaire specifically designed for assessing quality of life) resulted in a median score 68 (5-95) out of 100.
There was a significant effect on quality of life and an adverse psychological impact on those affected by faecal incontinence following OASIS.The average Vaizey score that grades incontinence from 0 to 22 resulted 11 in the participants to the study. 50% had urge FI (faecal incontinence), 33% had passive FI, 50% suffered from dyspareunia, 8% were no longer having sexual intercourse, 50% avoided long car journeys, 46% used pads (median 3.36 (1-7) per day), 66% used wet wipes, 8% used a radar key. The ICIQB questionnaire, a questionnaire evaluating symptoms of anal incontinence (including flatus incontinence) and impact on quality of life (QoL) on a scale from 1 to 10, reported the following. The average impact of urgency 7.3, flatus incontinence 7.6, unpredictable bowel accidents 6.2, the possibility of an accident 6.3, restriction of sex 5.5, FI related embarrassment 7, knowledge of nearest toilet 6.95, making plans in relation to the risk of FI 6.9, having to stay at home more 6 and overall effect of FI on daily life 6.7
Significant symptoms were reported by those affected by FI following OASIS. These affected many different aspects of their lives.
The extra cost associated with extra GP appointments was approximately £84 per month. Private healthcare costs of £3000 (consultant fees, therapeutic equipment,, irrigation, physiotherapy and mental health treatment were reported. Necessary changes to the patient’s home (downstairs lavatory etc) were deemed too expensive to undertake by some. Average extra monthly costs were reported, replacement of soiled clothing £42 (+/-36), extra laundry £3.7 (+/- 2.1), additional taxi costs £106.7, additional train fares £51.5, dietary changes £26.7, new sofa/ chairs £175, new mattress protectors £49.7, new bed linen £86.7 and extra childcare 9 (+/- 10) hours.
There is a significant economic impact on those affected by faecal incontinence following an OASISREC name
London - Westminster Research Ethics Committee
REC reference
20/LO/0225
Date of REC Opinion
15 May 2020
REC opinion
Further Information Favourable Opinion