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Obstetric risk factors for anorectal dysfunction after delivery: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

Pregnancy and childbirth are considered risk factors for pelvic floor dysfunction, including anorectal dysfunction. We aimed to assess the effect of obstetric events on anal incontinence and constipation after delivery.

Methods

We systematically reviewed the literature by searching MEDLINE, Embase and CENTRAL. We included studies in women after childbirth examining the association between obstetric events and anorectal dysfunction assessed through validated questionnaires. We selected eligible studies and clustered the data according to the type of dysfunction, obstetric event and interval from delivery. We assessed risk of bias using the Newcastle Ottawa Scale and we performed a random-effects meta-analysis and reported the results as odds ratios (ORs) with their 95% confidence intervals. Heterogeneity across studies was assessed using I2 statistics.

Results

Anal sphincter injury (OR: 2.44 [1.92–3.09]) and operative delivery were risk factors for anal incontinence (forceps—OR :1.35 [1.12–1.63]; vacuum—OR: 1.17 [1.04–1.31]). Spontaneous vaginal delivery increased the risk of anal incontinence compared with caesarean section (OR: 1.27 [1.07–1.50]). Maternal obesity (OR:1.48 [1.28–1.72]) and advanced maternal age (OR: 1.56 [1.30–1.88]) were risk factors for anal incontinence. The evidence on incontinence is of low certainty owing to the observational nature of the studies. No evidence was retrieved regarding constipation after delivery because of a lack of standardised validated assessment tools.

Conclusions

Besides anal sphincter injury, forceps delivery, maternal obesity and advanced age were associated with higher odds of anal incontinence, whereas caesarean section is protective. We could not identify obstetric risk factors for postpartum constipation, as few prospective studies addressed this question and none used a standardised validated questionnaire.

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Authors and Affiliations

  1. Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Laura Cattani, Liesbeth Neefs, Jan Bosteels & Jan Deprest

  2. Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium

    Laura Cattani, Liesbeth Neefs & Jan Deprest

  3. EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium

    Jan Y. Verbakel

  4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

    Jan Y. Verbakel

  5. Obstetrics and Gynaecology Unit, Imelda Hospital, Bonheiden, Belgium

    Jan Bosteels

  6. CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, Academic Centre for General Practice, Leuven, Belgium

    Jan Bosteels

  7. Research Department of Maternal Fetal Medicine, Institute for Women’s Health, University College London, London, UK

    Jan Deprest

Authors
  1. Laura Cattani
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  2. Liesbeth Neefs
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  3. Jan Y. Verbakel
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  4. Jan Bosteels
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  5. Jan Deprest
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Contributions

L. Cattani: protocol development and registration, data extraction, data analysis, manuscript writing, other (quality/risk of bias assessment) with L. Neefs; J.Y. Verbakel: manuscript editing, other (supervision of data analysis); J. Bosteels: protocol development, manuscript editing; J. Deprest: protocol development, manuscript editing.

Corresponding author

Correspondence to Jan Deprest.

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Cattani, L., Neefs, L., Verbakel, J.Y. et al. Obstetric risk factors for anorectal dysfunction after delivery: a systematic review and meta-analysis. Int Urogynecol J 32, 2325–2336 (2021). https://doi.org/10.1007/s00192-021-04723-z

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  • DOI: https://doi.org/10.1007/s00192-021-04723-z

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