Anal Incontinence After Vaginal Delivery: A Five-Year Prospective Cohort Study

Pollack, Johan; Nordenstam, Johan; Brismar, Sophia; López, Annika; Altman, Daniel; Zetterström, Jan

doi:10.1097/01.aog.0000147597.45349.e8

Cited by 169 publications

(126 citation statements)

References 16 publications

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“…Birth in water is not associated with an increased risk for AST and results in less episiotomies. Given the high rate of anal incontinence 5 years after an AST [14] , women should be informed before birth about the association of certain birth positions with the occurrence of AST. Due to the retrospective design of the study, our results have to be confirmed in a prospectively designed study.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Haslinger

Burkhardt

Stoiber

et al. 2014

Journal of Perinatal Medicine

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Objective:This work aimed to analyze the association between maternal position at birth in spontaneous deliveries and the occurrence of anal sphincter tears (AST) given the lack of evidence related to the least traumatic birth position. Study design: A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. Results: The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1.04-8.18) and in kneeling positions (OR 2.14, CI 95% 1.05-4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07-4.54). Conclusions: Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST. given the lack of evidence related to the least traumatic birth position. Study design : A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. Results : The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1. 04 -8.18) and in kneeling positions (OR 2.14, CI 95% 1.05 -4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07 -4.54). Conclusions : Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST.

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Section: Resultsmentioning

confidence: 99%

“…There is an established association between sphincter muscle damage and anal incontinence reaching up to 53% 5 years after delivery [14] . Furthermore, these defects have significant effects on emotional health, such as anxiety and depression [6] .…”

Section: Introductionmentioning

confidence: 99%

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study

Haslinger

Burkhardt

Stoiber

et al. 2014

Journal of Perinatal Medicine

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“…Pollack et al 3 demonstrated that women with subsequent childbirths had significantly elevated odds of anal incontinence, suggesting that, among women with one vaginal delivery, 58.3% of anal incontinence could be attributed to subsequent childbirths. Mant et al 4 found that, compared with nulliparous women, women with one child had four times higher odds and women with two children had 8.4 times higher odds of the development of pelvic organ prolapse (POP) requiring hospital admission.…”

Section: Authors' Replymentioning

confidence: 99%

Origins of ‘deep infiltrating endometriosis’

Kondo

Canis

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…3 Such complications are unsurprising given the extent and nature of the tissue injury, which includes wideranging denervation. It is also clear that extensive peripheral nerve injury results in changes in the central nervous system, such that surgery results in high rates of recurrent pain in the short to medium term.…”

Section: Sirmentioning

confidence: 99%