Women’s experiences of anal incontinence following a history of obstetric anal sphincter injury An interpretive phenomenological research study

Abstract

Anal incontinence (AI) has a debilitating and devastating impact on a person’s quality of life. However the impact is often unreported due to the social stigma that surrounds AI and the utilisation of ineffective symptom severity scores which accurately assess the impact on quality of life. There is a significant amount of research literature which addresses the prevalence and cause of AI. Less information addresses the increased risk of AI following vaginal delivery and damage to the anal sphincter. Furthermore, women’s experiences of AI following obstetric anal sphincter injury (OASIS) and the impact on their quality of life are poorly reflected within research literature. The research study reported within this thesis adds to the existing body of knowledge surrounding AI, OASIS and impact on quality of life. Accordingly findings from the reported study will assist health professionals to derive a greater understanding of the issues that surround AI and further promote the development of sensitive appropriate healthcare. The reported interpretive phenomenological study explored and interpreted ten women’s experiences of AI following a history of OASIS, and illuminated the impact of AI on their quality of life. Heidegger’s interpretive phenomenology and Van Manen’s methodological framework guided the reported research study. Semi-structured open ended interviews were adopted as they encouraged a relaxed informal discussion between the researcher and participant eliciting rich in-depth accounts of women’s experiences. Data collection, analysis and interpretation were undertaken utilising Van Manen’s procedural framework. This framework aided the development of three essential themes; grieving for loss, silence and striving for normality. The research findings highlighted the debilitating physical, social and emotional impact of AI on women’s lives. Women described the need to adopt strategies to cope with the impact of AI. These strategies included lifestyle changes, silence, avoidance and denial. Furthermore it was evident from within the findings that new knowledge had arisen. Women grieved the loss of their identity, and ability to form successful relationships and loss of control as an adult, a mother and a partner. Loss was further compounded by the insidious and unpredictable nature of AI which negatively impacted on women’s psychological wellbeing. Findings from the reported research study will challenge the reader’s current assumptions of AI and its impact on women’s quality of life. In addition, health professionals need to be well informed as to the risks and impact of vaginal delivery, OASIS and AI. Recommendations for health professionals practice include adopting a proactive approach in breaking the silence that surrounds AI, illuminating potential health issues and promoting sensitive appropriate health care and informed choice in birthing outcomes. Paucity within research literature and current findings provide the impetus for further research within the area of AI and importantly, the psychological impact of AI on women’s quality of life.