Faecal incontinence after childbirth

Abstract

Objective To measure the prevalence and severity of postpartum faecal incontinence, especially new Design A cohort study with information on symptoms collected in home-based interviews and obstetric Setting Deliveries from a maternity hospital in Birmingham. Participants Nine hundred and six women interviewed a mean of 10 months after delivery. Main outcome measures New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.Results Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.Conclusions Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.incontinence, and to identify obstetric risk factors.data from hospital casenotes.

Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth

“…The reported frequency of incontinence of stool in primiparous women ranges from 2 to 6% [MacArthur et al, 1997;Donnelly et al, 1998], and incontinence for either stool or £atus from 13 to 25% [Zetterstrom et al, 1999;Signorello et al, 2000]. After severe perineal laceration, the rate of anal incontinence rises to between 17 and 62% [Crawford et al, 1993;Sultan et al, 1993;Eason et al, 2002].…”

“…There is increasing evidence that instrumental delivery is a risk factor for the occurrence of muscle defects in the internal and external anal sphincter (IAS resp. EAS), depending on the type of instrument usedöfor example, forceps or vacuum extraction [Sultan et al, 1993;MacArthur et al, 1997]öor interventions such as an episiotomy [Coats et al, 1980;Sultan et al, 1993]. It could be shown that postpartal fecal incontinence was signi¢-cantly more likely to be associated with instrumental delivery than with spontaneous vaginal delivery [MacArthur et al, 1997].…”

The long‐term effectiveness of antenatal pelvic floor muscle training: eight‐year follow up of a randomised controlled trial

“…2 The risk is higher, and incontinence is likely to persist in the long term after onset during pregnancy. 3,4 Evidence suggests that vaginal delivery can contribute to damage to the pelvic floor through muscle and fascial injury as well as disrupting the nerve supply.…”

Three-dimensional transperineal ultrasonography for evaluation of the anal sphincter complex: another dimension in understanding peripartum sphincter trauma

“…It is reported in up to 19% of women, and greatly affects quality of life 1,2 . While pudendal nerve injury during delivery is a well-recognized reason for sphincter dysfunction, the main source of incontinence is direct sphincter injury, specifically third-and fourth-degree intrapartum tears.…”