Reviewer ’s report  
 
Title: Anal incontinence and unrecognized anal sphincter injuries after vaginal delivery - A 
cross -sectional  study in Norway  
 
Version: 1 Date: 27 Apr 2020  
 
Reviewer: Zeelha  Abdool  
 
Reviewer's report:  
 
Author:  
 
1. Abstract: Results:  
Please add a brief description of invited women, i.e. if they were previously primiparous, parous. 
Also add the mean time  of postpartum examination.  
Quantify 52.3% (n=…)  
 
2. Abstract: Conclusion:  
….2nd degree perineal lacerations is low - please quantify  
State the findings of your study instead of  …some obstetric anal sphincter injuries remain 
unrecognized at the time of deli very.  
 
3. Keywords: I disagree with colorectal surgery as a keyword  
 
4. Pg 1, L -36: Anal incontinence is rare following vaginal delivery…  
 
5. Pg 2,L -54: ..an estimate of 29 -55% of OASIS  are not recognized in the delivery ward.  
    Please elaborate on this a s your study is based on this theme  
 
6. Pg 2, L -56-58: Please rephrase ..To assess whether or not symptoms…before study 
participation.  
   You need to provide clarity on whether these women were primiparous, or parous.  
   Pg 2, L 61 - Please include a sentenc e or two on preventative delivery techniques in Norway…  
 
7. Pg 3: Methods: Line 57: Again qualify your statement: Participants were recruited among 
women who gave birth vaginally… these were previously primiparous or parous women?  
 
8. Pg 5, Results: What is  the mean postpartum time that these women were evaluated? Mean 
time for the questionnaire and mean time for the endoanal ultrasound.  
  …and 97 (n=…) of them also participated…  
 
9. Pg 6, L 136 -137: Add n= … for 4,1% and n=… for 26.1%  
 
10. Pg 7, L 161 -162: Explain your finding of 12.5% suffering from involuntary leakage of flatus 
on a weekly or daily basis. Is this comparable to the general population?  
10. Pg 9,L 202: At examination several months after delivery… ? Please add the mean t ime here 
as well  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify whi ch controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you  recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests' below.  
 
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