Аннотация

Резюме

Postpartum anal sphincter insufficiency (PPASI) is a frequent cause of fecal incontinence in women and has heterogeneous clinical patterns. This study aimed to identify clinical and laboratory predictors of recurrent and mixed phenotypes versus the residual phenotype and to evaluate their diagnostic performance.

Материал и методы

A single-center observational study (2021-2026) enrolled 86 women aged 18-45 years with symptoms persisting for at least 6 months after delivery. Patients were classified as recurrent (n=28), residual (n=22), or mixed (n=36). Age, parity, body mass index (BMI), hemoglobin (Hb), serum magnesium (Mg), and Wexner score were assessed; data are reported as median [Q1-Q3]. Pairwise diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis with optimal cutoffs by the Youden index; odds ratios (OR) for threshold rules were estimated using Fisher exact tests.

Результаты

Phenotypes differed in age, parity, Wexner score, Hb, Mg, and BMI (p<0.05). For mixed versus residual phenotype, the Wexner score demonstrated high accuracy (AUC 0.941; cutoff >=12; sensitivity 83.3%; specificity 95.5%) and Mg performed similarly (AUC 0.939; cutoff <=0.71 mmol/L; sensitivity 86.1%; specificity 86.4%). Age (AUC 0.876) and BMI (AUC 0.888) were also informative. For recurrent versus residual phenotype, Mg was the leading marker (AUC 0.934; cutoff <=0.72 mmol/L; sensitivity 85.7%; specificity 86.4%), followed by age (AUC 0.881), Wexner score (AUC 0.880), and Hb (AUC 0.860). Combined threshold rules showed strong associations with clinically relevant phenotypes.

Заключение

Routinely available markers show high diagnostic performance for differentiating PPASI phenotypes and may support early stratification. Prospective studies and external validation of cutoffs are required.

Ключевые слова

postpartum; fecal incontinence; anal sphincter; Wexner score; magnesium; body mass index.

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