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A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth

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Abstract

Introduction and hypothesis

Anal incontinence following childbirth is prevalent and has a significant impact upon quality of life (QoL). Currently, there is no standard assessment for women after childbirth to identify these symptoms. This systematic review aimed to identify non-invasive modalities used to identify women with anal incontinence following childbirth and assess response and reporting rates of anal incontinence for these modalities.

Methods

Ovid Medline, Allied and Complementary Medicine Database (AMED), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Collaboration, EMBASE and Web of Science databases were searched for studies using non-invasive modalities published from January 1966 to May 2018 to identify women with anal incontinence following childbirth. Study data including type of modality, response rates and reported prevalence of anal incontinence were extracted and critically appraised.

Results

One hundred and nine studies were included from 1602 screened articles. Three types of non-invasive modalities were identified: validated questionnaires/symptom scales (n = 36 studies using 15 different instruments), non-validated questionnaires (n = 50 studies) and patient interviews (n = 23 studies). Mean response rates were 92% up to 6 weeks after childbirth. Non-personalised assessment modalities (validated and non-validated questionnaires) were associated with reporting of higher rates of anal incontinence compared with patient interview at all periods of follow-up after childbirth, which was statistically significant between 6 weeks and 1 year after childbirth (p < 0.05).

Conclusions

This systematic review confirms that questionnaires can be used effectively after childbirth to identify women with anal incontinence. Given the methodological limitations associated with non-validated questionnaires, assessing all women following childbirth for pelvic-floor symptomatology, including anal incontinence, using validated questionnaires should be considered.

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References

  1. Sharma A, Yuan L, Marshall RJ, Merrie AE, Bissett IP. Systematic review of the prevalence of faecal incontinence. Br J Surg. 2016;103:1589–97.

    Article  CAS  PubMed  Google Scholar 

  2. Samarasekera DN, Bekhit MT, Wright Y, Lowndes RH, Stanley KP, Preston JP, et al. Long-term anal continence and quality of life following postpartum anal sphincter injury. Color Dis. 2008;10(8):793–9.

    Article  CAS  Google Scholar 

  3. Mellgren A, Jensen LL, Zetterström JP, Wong WD, Hofmeister JH, Lowry AC. Long-term cost of fecal incontinence secondary to obstetric injuries. Dis Colon Rectum. 1999;42(7):857–65.

    Article  CAS  PubMed  Google Scholar 

  4. Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Neurourol Urodyn. 2017;36(1):10–34.

    Article  PubMed  Google Scholar 

  5. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.

    Article  CAS  PubMed  Google Scholar 

  6. Brown HW, Wexner SD, Lukacz ES. Factors associated with care seeking among women with accidental bowel leakage. Female Pelvic Med Reconstr Surg. 2013;19(2):66–71.

    Article  PubMed  Google Scholar 

  7. Brown HW, Rogers RG, Wise ME. Barriers to seeking care for accidental bowel leakage: a qualitative study. Int Urogynecol J. 2017;28(4):543–51.

    Article  PubMed  Google Scholar 

  8. Thekkinkattil DK, Lim M, Finan PJ, Sagar PM, Burke D. Awareness of investigations and treatment of faecal incontinence among the general practitioners: a postal questionnaire survey. Color Dis. 2008;10(3):263–7.

    Article  CAS  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9.

    Article  Google Scholar 

  11. Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Policy Manag. 2014;3(3):123.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fynes M, Donnelly VS, O’Connell PR, O’Herlihy C. Cesarean delivery and anal sphincter injury. Obstet Gynecol. 1998;92(4):496–500.

    CAS  PubMed  Google Scholar 

  13. Solans-Domènech M, Sánchez E, Espuña-Pons M. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol. 2010;115(3):618–28.

    Article  PubMed  Google Scholar 

  14. Frudinger A, Halligan S, Bartram CI, Spencer J, Kamm MA, Winter R. Assessment of the predictive value of a bowel symptom questionnaire in identifying perianal and anal sphincter trauma after vaginal delivery. Dis Colon Rectum. 2003;46(6):742–7.

    Article  PubMed  Google Scholar 

  15. Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C. Obstetric events leading to anal sphincter damage. Obstet Gynecol. 1998;92(6):955–61.

    CAS  PubMed  Google Scholar 

  16. Rogers RG, Leeman LM, Borders N, Qualls C, Fullilove AM, Teaf D, et al. Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. BJOG Int J Obstet Gynaecol. 2014;121(9):1145–54.

    Article  CAS  Google Scholar 

  17. Hatem M, Pasquier JC, Fraser W, Lepire E. Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec. J Obstet Gynaecol Can. 2007;29(3):232–9.

    Article  PubMed  Google Scholar 

  18. Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women. Birth. 2016;43(4):293–302.

    Article  PubMed  Google Scholar 

  19. Johannessen H, Wibe A, Stordahl A, Sandvik L, Backe B, Mørkved S. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG Int J Obstet Gynaecol. 2014;121(3):269–80.

    Article  CAS  Google Scholar 

  20. Chan SS, Cheung RY, Yiu KW, Lee LL, Chung TK. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2013;24(9):1473–9.

    Article  PubMed  Google Scholar 

  21. Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women. Int Urogynecol J. 2014;25(10):1363–74.

    Article  CAS  PubMed  Google Scholar 

  22. Gartland D, MacArthur C, Woolhouse H, McDonald E, Brown SJ. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort. BJOG Int J Obstet Gynaecol. 2016;123(7):1203–11.

    Article  CAS  Google Scholar 

  23. Damon H, Bretones S, Henry L, Mellier G, Mion F. Long-term consequences of first vaginal delivery-induced anal sphincter defect. Dis Colon Rectum. 2005;48(9):1772–6.

    Article  PubMed  Google Scholar 

  24. Evers EC, Blomquist JL, McDermott KC, Handa VL. Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth. Am J Obstet Gynecol. 2012;207(5):425–e1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dolan LM, Hilton P. Obstetric risk factors and pelvic floor dysfunction 20 years after first delivery. Int Urogynecol J. 2010;21(5):535–44.

    Article  PubMed  Google Scholar 

  26. Nilsson I, Åkervall S, Milsom I, Gyhagen M. Long-term effects of vacuum extraction on pelvic floor function: a cohort study in primipara. Int Urogynecol J. 2016;27(7):1051–6.

    Article  PubMed  Google Scholar 

  27. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG Int J Obstet Gynaecol. 2013;120(2):144–51.

    Article  CAS  Google Scholar 

  28. Soligo M, Livio S, De Ponti E, Scebba I, Carpentieri F, Serati M, et al. Pelvic floor assessment after delivery: how should women be selected? Eur J Obstet Gynecol Reprod Biol. 2016;206:153–7.

    Article  PubMed  Google Scholar 

  29. Torrisi G, Minini G, Bernasconi F, Perrone A, Trezza G, Guardabasso V, et al. A prospective study of pelvic floor dysfunctions related to delivery. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):110–5.

    Article  PubMed  Google Scholar 

  30. Pinta TM, Kylänpää ML, Teramo KA, Luukkonen PS. Sphincter rupture and anal incontinence after first vaginal delivery. Acta Obstet Gynecol Scand. 2004;83(10):917–22.

    Article  PubMed  Google Scholar 

  31. Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M. Incidence of fecal incontinence after childbirth. Obstet Gynecol. 2007;109(2, Part 1):281–8.

    Article  PubMed  Google Scholar 

  32. Wagenius J, Laurin J. Clinical symptoms after anal sphincter rupture: a retrospective study. Acta Obstet Gynecol Scand. 2003;82(3):246–50.

    Article  PubMed  Google Scholar 

  33. Mous M, Muller SA, De Leeuw JW. Long-term effects of anal sphincter rupture during vaginal delivery: Faecal incontinence and sexual complaints. BJOG Int J Obstet Gynaecol. 2008;115(2):234–8.

    Article  CAS  Google Scholar 

  34. Baud D, Meyer S, Vial Y, Hohlfeld P, Achtari C. Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Int Urogynecol J. 2011;22(9):1127–34.

    Article  PubMed  Google Scholar 

  35. Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118(4):777.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Altman D, Ekström Å, Forsgren C, Nordenstam J, Zetterström J. Symptoms of anal and urinary incontinence following cesarean section or spontaneous vaginal delivery. Am J Obstet Gynecol. 2007;197(5):512–e1.

    Article  PubMed  Google Scholar 

  37. Faltin DL, Otero M, Petignat P, Sangalli MR, Floris LA, Boulvain M, et al. Women’s health 18 years after rupture of the anal sphincter during childbirth: I. fecal incontinence. Am J Obstet Gynecol. 2006;194(5):1255–9.

    Article  PubMed  Google Scholar 

  38. Soerensen MM, Buntzen S, Bek KM, Laurberg S. Complete obstetric anal sphincter tear and risk of long-term fecal incontinence: a cohort study. Dis Colon Rectum. 2013;56(8):992–1001.

    Article  PubMed  Google Scholar 

  39. Fritel X, Ringa V, Varnoux N, Zins M, Bréart G. Mode of delivery and fecal incontinence at midlife: a study of 2,640 women in the Gazel cohort. Obstet Gynecol. 2007;110(1):31–8.

    Article  PubMed  Google Scholar 

  40. Vaccaro C, Clemons JL. Anal sphincter defects and anal incontinence symptoms after repair of obstetric anal sphincter lacerations in primiparous women. Int Urogynecol J. 2008;19(11):1503–8.

    Article  Google Scholar 

  41. Andrews V, Thakar R, Sultan AH. Outcome of obstetric anal sphincter injuries (OASIS)—role of structured management. Int Urogynecol J. 2009;20(8):973.

    Article  Google Scholar 

  42. Norderval S, Nsubuga D, Bjelke C, Frasunek J, Myklebust I, Vonen B. Anal incontinence after obstetric sphincter tears: incidence in a Norwegian county. Acta Obstet Gynecol Scand. 2004;83(10):989–94.

    Article  PubMed  Google Scholar 

  43. Richter HE, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J, et al. Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. 2012;21(4):182.

    Article  Google Scholar 

  44. Tin RY, Schulz J, Gunn B, Flood C, Rosychuk RJ. The prevalence of anal incontinence in post-partum women following obstetrical anal sphincter injury. Int Urogynecol J. 2010;21(8):927–32.

    Article  PubMed  Google Scholar 

  45. Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Mode of delivery after obstetric anal sphincter injury and the risk of long-term anal incontinence. Am J Obstet Gynecol. 2016;214(6):733–e1.

    Article  PubMed  Google Scholar 

  46. Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C. Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. BJOG Int J Obstet Gynaecol. 2003;110(4):424–9.

    Article  Google Scholar 

  47. Rieger N, Schloithe A, Saccone G, Wattchow D. A prospective study of anal sphincter injury due to childbirth. Scand J Gastroenterol. 1998;33(9):950–5.

    Article  CAS  PubMed  Google Scholar 

  48. Zetterström J, Mellgren A, Jensen LL, Wong WD, Kim DG, Lowry AC, et al. Effect of delivery on anal sphincter morphology and function. Dis Colon Rectum. 1999;42(10):1253–60.

    Article  PubMed  Google Scholar 

  49. Donnelly VS, O’herlihy C, Campbell DM, O’Connell PR. Postpartum fecal incontinence is more common in women with irritable bowel syndrome. Dis Colon Rectum. 1998;41(5):586–9.

    Article  CAS  PubMed  Google Scholar 

  50. Faltin DL, Sangalli MR, Roche B, Floris L, Boulvain M, Weil A. Does a second delivery increase the risk of anal incontinence? BJOG Int J Obstet Gynaecol. 2001;108(7):684–8.

    Article  CAS  Google Scholar 

  51. Chaliha C, Sultan AH, Bland JM, Monga AK, Stanton SL. Anal function: effect of pregnancy and delivery. Am J Obstet Gynecol. 2001;185(2):427–32.

    Article  CAS  PubMed  Google Scholar 

  52. Faltin DL, Boulvain M, Irion O, Bretones S, Stan C, Weil A. Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstet Gynecol. 2000;95(5):643–7.

    CAS  PubMed  Google Scholar 

  53. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189(6):1543–9.

    Article  PubMed  Google Scholar 

  54. Zetterstrom JP, López A, Anzén BO, Dolk A, Norman M, Mellgren A. Anal incontinence after vaginal delivery: a prospective study in primiparous women. BJOG Int J Obstet Gynaecol. 1999;106(4):324–30.

    Article  CAS  Google Scholar 

  55. van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH. Defecatory symptoms during and after the first pregnancy: prevalences and associated factors. Int Urogynecol J. 2006;17(3):224–30.

    Article  Google Scholar 

  56. Brown SJ, Gartland D, Donath S, MacArthur C. Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice. Obstet Gynecol. 2012;119(2):240–9.

    Article  PubMed  Google Scholar 

  57. Svare JA, Hansen BB, Lose G. Prevalence of anal incontinence during pregnancy and 1 year after delivery in a cohort of primiparous women and a control group of nulliparous women. Acta Obstet Gynecol Scand. 2016;95(8):920–5.

    Article  PubMed  Google Scholar 

  58. Koops SS, Vervest HA, Oostvogel HJ. Anorectal symptoms after various modes of vaginal delivery. Int Urogynecol J. 2003;14(4):244–9.

    Article  Google Scholar 

  59. Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J. Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol. 2004;104(6):1397–402.

    Article  PubMed  Google Scholar 

  60. Nordenstam J, Altman D, Brismar S, Zetterström J. Natural progression of anal incontinence after childbirth. Int Urogynecol J. 2009;20(9):1029–35.

    Article  Google Scholar 

  61. Gyhagen M, Åkervall S, Milsom I. Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. Int Urogynecol J. 2015;26(8):1115–21.

    Article  PubMed  Google Scholar 

  62. Halle TK, Salvesen KÅ, Volløyhaug I. Obstetric anal sphincter injury and incontinence 15–23 years after vaginal delivery. Acta Obstet Gynecol Scand. 2016;95(8):941–7.

    Article  PubMed  Google Scholar 

  63. Rajeshkannan N, Pathmeswaran A. Prevalence of postpartum anal incontinence: a cross sectional study in northern Sri Lanka. Ceylon Med J. 2013;58(2):76–9.

    Article  CAS  PubMed  Google Scholar 

  64. Hall W, McCracken K, Osterweil P, Guise JM. Frequency and predictors for postpartum fecal incontinence. Am J Obstet Gynecol. 2003;188(5):1205–7.

    Article  PubMed  Google Scholar 

  65. Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, et al. Are sphincter defects the cause of anal incontinence after vaginal delivery? Dis Colon Rectum. 2000;43(5):590–6.

    Article  CAS  PubMed  Google Scholar 

  66. Hannah ME, Hannah WJ, Hodnett E, Chalmers B, Kung R, Willan A, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized term breech trial. JAMA. 2002;287(14):1822–31.

    Article  PubMed  Google Scholar 

  67. Haadem K, Dahlström JA, Lingman G. Anal sphincter function after delivery: a prospective study in women with sphincter rupture and controls. Eur J Obstet Gynecol Reprod Biol. 1990;35(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  68. MacArthur C, Glazener CM, Wilson PD, Herbison GP, Gee H, Lang GD, et al. Obstetric practice and faecal incontinence three months after delivery. BJOG Int J Obstet Gynaecol. 2001;108(7):678–83.

    Article  CAS  Google Scholar 

  69. Eason E, Labrecque M, Marcoux S, Mondor M. Anal incontinence after childbirth. Can Med Assoc J. 2002;166(3):326–30.

    Google Scholar 

  70. Obioha KC, Ugwu EO, Obi SN, Dim CC, Oguanuo TC. Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women. Int Urogynecol J. 2015;26(9):1347–54.

    Article  PubMed  Google Scholar 

  71. Glazener CM, Abdalla M, Stroud P, Templeton A, Russell IT, Naji S. Postnatal maternal morbidity: extent, causes, prevention and treatment. BJOG Int J Obstet Gynaecol. 1995;102(4):282–7.

    Article  CAS  Google Scholar 

  72. Palm A, Israelsson L, Bolin M, Danielsson I. Symptoms after obstetric sphincter injuries have little effect on quality of life. Acta Obstet Gynecol Scand. 2013;92(1):109–15.

    Article  PubMed  Google Scholar 

  73. Ryhammer AM, Bek KM, Laurberg S. Multiple vaginal deliveries increase the risk of permanent incontinence of flatus and urine in normal premenopausal women. Dis Colon Rectum. 1995;38(11):1206–9.

    Article  CAS  PubMed  Google Scholar 

  74. Fornell EU, Matthiesen L, Sjödahl R, Berg G. Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG Int J Obstet Gynaecol. 2005;112(3):312–6.

    Article  Google Scholar 

  75. Glazener CM, MacArthur C, Hagen S, Elders A, Lancashire R, Herbison GP, et al. Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes: randomised controlled trial. BJOG Int J Obstet Gynaecol. 2014;121(1):112–20.

    Article  CAS  Google Scholar 

  76. MacArthur C, Glazener C, Lancashire R, Herbison P, Wilson D. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG Int J Obstet Gynaecol. 2011;118(8):1001–7.

    Article  CAS  Google Scholar 

  77. Nygaard IE, Rao SS, Dawson JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol. 1997;89(6):896–901.

    Article  CAS  PubMed  Google Scholar 

  78. Bollard RC, Gardiner A, Duthie GS, Lindow SW. Anal sphincter injury, fecal and urinary incontinence. Dis Colon Rectum. 2003;46(8):1083–8.

    Article  PubMed  Google Scholar 

  79. McKinnie V, Swift SE, Wang W, Woodman P, O’boyle A, Kahn M, et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol. 2005;193(2):512–7.

    Article  PubMed  Google Scholar 

  80. Goldberg RP, Kwon C, Gandhi S, Atkuru LV, Sorensen M, Sand PK. Prevalence of anal incontinence among mothers of multiples and analysis of risk factors. Am J Obstet Gynecol. 2003;189(6):1627–30.

    Article  PubMed  Google Scholar 

  81. Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ. 1994;308(6933):887–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Haadem K, Ohrlander S, Lingman G. Long-term ailments due to anal sphincter rupture caused by delivery—a hidden problem. Eur J Obstet Gynecol Reprod Biol. 1988;27(1):27–32.

    Article  CAS  PubMed  Google Scholar 

  83. Chaliha C, Kalia V, Stanton SL, Monga AS, Sultan AH. Antenatal prediction of postpartum urinary and fecal incontinence. Obstet Gynecol. 1999;94(5):689–94.

    CAS  PubMed  Google Scholar 

  84. Uustal Fornell EK, Berg G, Haalböök O, Matthiesen LS, Sjödahl R. Clinical consequences of anal sphincter rupture during vaginal delivery. J Am Coll Surg. 1996;183(6):553–8.

    Google Scholar 

  85. Mazouni C, Bretelle F, Battar S, Bonnier P, Gamerre M. Frequency of persistent anal symptoms after first instrumental delivery. Dis Colon Rectum. 2005;48(7):1432–6.

    Article  PubMed  Google Scholar 

  86. Tetzschner T, Sorensen M, Lose G, Christiansen J. Anal and urinary incontinence in women with obstetric anal sphincter rupture. Int J Gynecol Obstet. 1997;56(2):222.

    Google Scholar 

  87. Haadem K, Ling L, Dahlstrom A, Ohrlander S. Anal sphincter function after delivery rupture. Obstet Gynecol. 1987;70(1):53–6.

    CAS  PubMed  Google Scholar 

  88. Gjessing H, Backe B, Sahlin Y. Third degree obstetric tears; outcome after primary repair. Acta Obstet Gynecol Scand. 1998;77(7):736–40.

    Article  CAS  PubMed  Google Scholar 

  89. Kumar R. Anal incontinence and quality of life following obstetric anal sphincter injury. Arch Gynecol Obstet. 2012;285(3):591–7.

    Article  PubMed  Google Scholar 

  90. Poen AC, Felt-Bersma RJ, Strijers RL, Dekker GA, Cuesta MA, Meuwissen SG. Third-degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg. 1998;85(10):1433–8.

    Article  CAS  PubMed  Google Scholar 

  91. Sørensen SM, Bondesen H, Istre O, Vilmann P, Serensen SM. Perineal rupture following vaginal delivery long-term consequences. Acta Obstet Gynecol Scand. 1988;67(4):315–8.

    Article  Google Scholar 

  92. de Leeuw JW, Vierhout ME, Struijk PC, Auwerda HJ, Bac DJ, Wallenburg HC. Anal sphincter damage after vaginal delivery. Dis Colon Rectum. 2002;45(8):1004–10.

    Article  PubMed  Google Scholar 

  93. Sultan AH, Johanson RB, Carter JE. Occult anal sphincter trauma following randomized forceps and vacuum delivery. Int J Gynecol Obstet. 1998;61(2):113–9.

    Article  CAS  Google Scholar 

  94. Johanson RB, Heycock E, Carter J, Sultan AH, Walklate K, Jones PW. Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse. BJOG Int J Obstet Gynaecol. 1999;106(6):544–9.

    Article  CAS  Google Scholar 

  95. Kunduru L, Kim SM, Heymen S, Whitehead WE. Factors that affect consultation and screening for fecal incontinence. Clin Gastroenterol Hepatol. 2015;13(4):709–16.

    Article  PubMed  Google Scholar 

  96. Belmonte-Montes C, Hagerman G, Vega-Yepez PA, Hernández-de-Anda E, Fonseca-Morales V. Anal sphincter injury after vaginal delivery in primiparous females. Dis Colon Rectum. 2001;44(9):1244–8.

    Article  CAS  PubMed  Google Scholar 

  97. Meyer S, Schreyer A, De Grandi P, Hohlfeld P. The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics. Obstet Gynecol. 1998;92(4):613–8.

    CAS  PubMed  Google Scholar 

  98. Groutz A, Fait G, Lessing JB, David MP, Wolman I, Jaffa A, et al. Incidence and obstetric risk factors of postpartum anal incontinence. Scand J Gastroenterol. 1999;34(3):315–8.

    CAS  PubMed  Google Scholar 

  99. Farrell SA, Allen VM, Baskett TF. Anal incontinence in primiparas. J SOGC. 2001;23(4):321–6.

    Article  Google Scholar 

  100. Borello-France D, Burgio KL, Richter HE, Zyczynski H, FitzGerald MP, Whitehead W, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108(4):863–72.

    Article  PubMed  Google Scholar 

  101. Yang X, Zhang HX, Yu HY, Gao XL, Yang HX, Dong Y. The prevalence of fecal incontinence and urinary incontinence in primiparous postpartum Chinese women. Eur J Obstet Gynecol Reprod Biol. 2010;152(2):214–7.

    Article  PubMed  Google Scholar 

  102. Jelovsek JE, Piccorelli A, Barber MD, Tunitsky-Bitton E, Kattan MW. Prediction models for postpartum urinary and fecal incontinence in primiparous women. Female Pelvic Med Reconstr Surg. 2013;19(2):110–8.

    Article  PubMed  Google Scholar 

  103. Crawford LA, Quint EH, Pearl ML, DeLancey JO. Incontinence following rupture of the anal sphincter during delivery. Obstet Gynecol. 1993;82(4):527–31.

    CAS  PubMed  Google Scholar 

  104. Lal M, Mann CH, Callender R, Radley S. Does cesarean delivery prevent anal incontinence? Obstet Gynecol. 2003;101(2):305–12.

    PubMed  Google Scholar 

  105. Brincat C, Lewicky-Gaupp C, Patel D, Sampselle C, Miller J, DeLancey JO, et al. Fecal incontinence in pregnancy and post partum. Int J Gynecol Obstet. 2009;106(3):236–8.

    Article  Google Scholar 

  106. Lipschuetz M, Cohen SM, Liebergall-Wischnitzer M, Zbedat K, Hochner-Celnikier D, Lavy Y, et al. Degree of bother from pelvic floor dysfunction in women one year after first delivery. Eur J Obstet Gynecol Reprod Biol. 2015;191:90–4.

    Article  PubMed  Google Scholar 

  107. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329(26):1905–11.

    Article  CAS  PubMed  Google Scholar 

  108. Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour: prospective study before and after childbirth. BJOG Int J Obstet Gynaecol. 1994;101(1):22–8.

    Article  CAS  Google Scholar 

  109. Tetzschner T, Sørensen M, Jønsson L, Lose G, Christiansen J. Delivery and pudendal nerve function. Acta Obstet Gynecol Scand. 1997;76(4):324–31.

    Article  CAS  PubMed  Google Scholar 

  110. Baydock SA, Flood C, Schulz JA, MacDonald D, Esau D, Jones S, et al. Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery. J Obstet Gynaecol Can. 2009;31(1):36–41.

    Article  PubMed  Google Scholar 

  111. MacArthur C, Bick DE, Keighley MR. Faecal incontinence after childbirth. BJOG Int J Obstet Gynaecol. 1997;104(1):46–50.

    Article  CAS  Google Scholar 

  112. Sørensen M, Tetzschner T, Rasmussen OØ, Bjarnesen J, Christiansen J. Sphincter rupture in childbirth. Br J Surg. 1993;80(3):392–4.

    Article  PubMed  Google Scholar 

  113. Walsh CJ, Mooney EF, Upton GJ, Motson RW. Incidence of third-degree perineal tears in labour and outcome after primary repair. Br J Surg. 1996;83(2):218–21.

    Article  CAS  PubMed  Google Scholar 

  114. Laine K, Skjeldestad FE, Sanda B, Horne H, Spydslaug A, Staff AC. Prevalence and risk factors for anal incontinence after obstetric anal sphincter rupture. Acta Obstet Gynecol Scand. 2011;90(4):319–24.

    Article  PubMed  Google Scholar 

  115. Size EH. Prevalence and severity of anal incontinence in women with and without additional vaginal deliveries after a fourth-degree perineal laceration. Dis Colon Rectum. 2005;48(1):66–9.

    Article  Google Scholar 

  116. Sangalli MR, Floris L, Faltin D, Weil A. Anal incontinence in women with third or fourth degree perineal tears and subsequent vaginal deliveries. Aust N Z J Obstet Gynaecol. 2000;40(3):244–8.

    Article  CAS  PubMed  Google Scholar 

  117. Size EH. Anal incontinence among women with one versus two complete third-degree perineal lacerations. Int J Gynecol Obstet. 2005;90(3):213–7.

    Article  Google Scholar 

  118. Sultan AH, Kamm MA, Bartram CI, Hudson CN. Anal sphincter trauma during instrumental delivery. Int J Gynecol Obstet. 1993;43(3):263–70.

    Article  CAS  Google Scholar 

  119. Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Dis Colon Rectum. 1992;35(5):482–7.

    Article  CAS  PubMed  Google Scholar 

  120. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185(6):1388–95.

    Article  CAS  PubMed  Google Scholar 

  121. Lukacz ES, Lawrence JM, Buckwalter JG, Burchette RJ, Nager CW, Luber KM. Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J. 2005;16(4):272–84.

    Article  Google Scholar 

  122. Reilly WT, Talley NJ, Pemberton JH, Zinsmeister AR. Validation of a questionnaire to assess fecal incontinence and associated risk factors. Dis Colon Rectum. 2000;43(2):146–53.

    Article  CAS  PubMed  Google Scholar 

  123. Baessler K, O’Neill SM, Maher CF, Battistutta D. Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J. 2009;20(2):149–58.

    Article  Google Scholar 

  124. Talley NJ, Newman P, Boyce PM, Paterson KJ, Owen BK. Initial validation of a bowel symptom questionnaire* and measurement of chronic gastrointestinal symptoms in Australians. Aust NZ J Med. 1995;25(4):302–8.

    Article  CAS  Google Scholar 

  125. Maeda Y, Vaizey CJ, Norton C. St. Mark’s incontinence score. Dis Colon Rectum. 2007;50(12):2252.

    Article  PubMed  Google Scholar 

  126. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Browning GG, Parks AG. Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg. 1983;70(2):101–4.

    Article  CAS  PubMed  Google Scholar 

  128. Hiller L, Radley S, Mann CH, Radley SC, Begum G, Pretlove SJ, et al. Development and validation of a questionnaire for the assessment of bowel and lower urinary tract symptoms in women. BJOG Int J Obstet Gynaecol. 2002;109(4):413–23.

    Article  CAS  Google Scholar 

  129. Radley SC, Jones GL, Tanguy EA, Stevens VG, Nelson C, Mathers NJ. Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. BJOG Int J Obstet Gynaecol. 2006;113(2):231–8.

    Article  CAS  Google Scholar 

  130. Bugg GJ, Kiff ES, Hosker G. A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. BJOG Int J Obstet Gynaecol. 2001;108(10):1057–67.

    Article  Google Scholar 

  131. Kwon S, Visco AG, Fitzgerald MP, Ye W, Whitehead WE. Pelvic floor disorders network. Validity and reliability of the modified Manchester health questionnaire in assessing patients with fecal incontinence. Dis Colon Rectum. 2005;48(2):323–34.

    Article  PubMed  Google Scholar 

  132. Due U, Ottesen M. The Danish anal sphincter rupture questionnaire: validity and reliability. Acta Obstet Gynecol Scand. 2009;88(1):36–42.

    Article  PubMed  Google Scholar 

  133. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal incontinence quality of life scale. Dis Colon Rectum. 2000;43(1):9–16.

    Article  CAS  PubMed  Google Scholar 

  134. Rasmussen JL, Ringsberg KC. Being involved in an everlasting fight–a life with postnatal faecal incontinence. A qualitative study. Scand J Caring Sci. 2010;24(1):108–15.

    Article  PubMed  Google Scholar 

  135. Heymen S, Palsson O, Simren M, Whitehead WE. Patient preferences for endpoints in fecal incontinence treatment studies. Neurogastroenterol Motil. 2017;29:e13032.

    Article  Google Scholar 

  136. Sultan AH. Obstetrical perineal injury and anal incontinence. Clin Risk. 1999;5(6):193–6.

    Google Scholar 

  137. Patterns of maternity care in English NHS Hospitals 2013/2014. Available at: https://www.rcog.org.uk/en/guidelines-research-services/audit-quality-improvement/clinical-indicators-project/ Accessed 20 Jan 2018.

  138. Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013;120:1516–25.

    Article  CAS  PubMed  Google Scholar 

  139. The OASI Care Bundle Project. Royal College of Obstetricians and Gynaecologists. Available at: https://www.rcog.org.uk/OASICareBundle Accessed 20 Jan 2018.

  140. Poulsen MØ, Madsen ML, Skriver-Møller AC, Overgaard C. Does the Finnish intervention prevent obstetric anal sphincter injuries? A systematic review of the literature. BMJ Open. 2015;5(9):e008346.

    Article  PubMed  PubMed Central  Google Scholar 

  141. Bachman JW. The patient-computer interview: a neglected tool that can aid the clinician. Mayo Clin Proc. 2003;78:67–78.

    Article  PubMed  Google Scholar 

  142. Gray T, Li W, Campbell P, et al. Evaluation of coital incontinence by electronic questionnaire: prevalence, associations and outcomes in women attending a urogynaecology clinic. Int Urogynecol J. 2017. https://doi.org/10.1007/s00192-017-3380-x.

  143. Dowrick AS, Wootten AC, Murphy DG, Costello AJ. “We used a validated questionnaire”: what does this mean and is it an accurate statement in urologic research? Urology. 2015;85(6):1304–11.

    Article  PubMed  Google Scholar 

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Acknowledgements

The researchers would like to acknowledge the MASIC Foundation and Professor Michael Keighley for providing the impetus for this systematic review and a further planned programme of research and service delivery on this subject.

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Authors and Affiliations

  1. Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, c/o Tricia Kenyon, Level 4, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK

    Thomas G. Gray, Holly Vickers, Swati Jha & Stephen C. Radley

  2. Leeds Beckett University, Leeds, UK

    Georgina L. Jones

  3. Department of Colorectal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    Steven R. Brown

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  1. Thomas G. Gray
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  2. Holly Vickers
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  3. Swati Jha
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  4. Georgina L. Jones
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  6. Stephen C. Radley
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Correspondence to Thomas G. Gray.

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Conflicts of interest

Professor Stephen Radley is a director and shareholder of ePAQ Systems Limited, an NHS spin-out technology company, largely owned by Sheffield Teaching Hospitals NHS Foundation Trust. Mr. Radley did not collect or analyse the data included in this systematic review.

The other authors have no financial or commercial interests in ePAQ Systems Ltd. or other conflicts of interest to declare.

Electronic supplementary material

Supplementary Table 1

Summary of results for studies using validated patient-reported outcome measures or symptom scales to identify anal incontinence in women after childbirth, including the language in which each study was undertaken. (DOCX 29 kb)

Supplementary Table 2

Summary of results for studies using non-validated questionnaires to identify anal incontinence in women after childbirth. (DOCX 28 kb)

Supplementary Table 3

Summary of results for studies using patient interviews to identify faecal incontinence in women after childbirth. (DOCX 89 kb)

Supplementary Table 4

Response rates for different follow-up periods. (DOCX 70 kb)

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Gray, T.G., Vickers, H., Jha, S. et al. A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth. Int Urogynecol J 30, 869–879 (2019). https://doi.org/10.1007/s00192-018-3819-8

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