Anal incontinence among first time mothers – What happens in pregnancy and the first year after delivery?. (23rd June 2015)

• Record Type: Journal Article
• Authors: Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv; Mørkved, Siv
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 94:Number 9(2015)
• Page Start: 1005
• Page End: 1013
• Publication Date: 2015-06-23
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12689
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12689-abs-0001"> <title>Abstract</title> <sec id="aogs12689-sec-0001" sec-type="section"> <title>Introduction</title> <p>Pregnancy‐ and delivery‐related factors affect postpartum anal incontinence. We aimed to explore changes in continence status among primiparas from late pregnancy through the first year postpartum.</p> </sec> <sec id="aogs12689-sec-0002" sec-type="section"> <title>Material and methods</title> <p>In this prospective cohort study set in two Norwegian hospitals, 862 healthy primiparas completed questionnaires about the main outcome measure anal incontinence, including flatus incontinence and urgency, at three time points; late pregnancy, 6 and 12 months postpartum. Socioeconomic and delivery‐related data were obtained from hospital records. Logistic regression analyses were applied to determine the association between continence status at 12 months postpartum, and continence status in late pregnancy, 6 months postpartum, demographic and delivery‐related characteristics.</p> </sec> <sec id="aogs12689-sec-0003" sec-type="section"> <title>Results</title> <p>Among the 189 (22%) primiparas reporting anal incontinence in late pregnancy, 34 (18%) had persistent anal incontinence 1 year later. Forty‐eight (43%) of the 113 women incontinent at 6 months postpartum experienced persistent anal incontinence at 12 months. Eight percent of previously continent women reported new onset anal incontinence at 6 and 12 months after delivery. Occipitoposterior presentation was the only delivery‐related factor increasing the risk of postpartum anal incontinence [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.0–3.4]. Young age increased the risk of anal incontinence at 1 year after delivery, whereas incontinence in late pregnancy increased the risk of anal incontinence persisting through 6 and 12 months postpartum.</p> </sec> <sec id="aogs12689-sec-0004" sec-type="section"> <title>Conclusion</title> <p>In most first‐time mothers with postpartum anal incontinence, the onset of anal incontinence was before delivery. Except for occipitoposterior presentation, no delivery‐related factors increased the risk of postpartum anal incontinence. This may indicate that hormonal, mechanical or neuromuscular changes in pregnancy affect long‐term anal incontinence more than vaginal delivery.</p> </sec> </abstract>