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International Urogynecology Journal

, Volume 20, Issue 1, pp 61–67 | Cite as

Does cesarean protect against fecal incontinence in primiparous women?

  • Jeanne-Marie GuiseEmail author
  • Sarah Hamilton Boyles
  • Patricia Osterweil
  • Hong Li
  • Karen B. Eden
  • Motomi Mori
Original Article

Abstract

The objective of this study was to identify factors associated with new onset of postpartum fecal incontinence in primiparous women. A population-based study was conducted that surveyed all women delivering between 2002 and 2003 in Oregon. Factors associated with fecal incontinence were identified using logistic regression analysis. A total of 6,152 primiparous women completed the survey 3–6 months postpartum with 2,482 reporting a new onset of fecal incontinence (FI) after childbirth. Vaginal delivery was associated with a greater risk of FI compared to cesarean (odds ratio = 1.45; 95% confidence interval, 1.29 to 1.64). However, vaginal delivery without laceration or instrument assistance did not increase the risk of FI over cesarean. Being overweight (body mass index ≥30 kg/m2), pushing for greater than 2 h, and constipation were independently associated with postpartum FI (p < 0.05) regardless of route of delivery. This study provides important data to inform counseling and management of primiparous women.

Keywords

Cesarean section Delivery Epidemiologic studies Fecal incontinence Pregnancy Risk factors 

References

  1. 1.
    National Institutes of Health (1998) Conference for researchers in female pelvic floor disorders. NIH Terminology WorkshopGoogle Scholar
  2. 2.
    Rothbarth J, Bemelman WA, Meijerink WJ, Stiggelbout AM, Zwinderman AH, Buyze-Westerweel ME et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44:67–71PubMedCrossRefGoogle Scholar
  3. 3.
    Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36PubMedGoogle Scholar
  4. 4.
    Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG et al (1993) U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 38:1569–1580PubMedCrossRefGoogle Scholar
  5. 5.
    Nelson R, Norton N, Cautley E, Furner S (1995) Community-based prevalence of anal incontinence. JAMA 274:559–561PubMedCrossRefGoogle Scholar
  6. 6.
    Kok AL, Voorhorst FJ, Burger CW, van Houten P, Kenemans P, Janssens J (1992) Urinary and faecal incontinence in community-residing elderly women. Age Ageing 21:211–215PubMedCrossRefGoogle Scholar
  7. 7.
    Roberts RO, Jacobsen SJ, Reilly WT, Pemberton JH, Lieber MM, Talley NJ (1999) Prevalence of combined fecal and urinary incontinence: a community-based study. J Am Geriatr Soc 47:837–841PubMedGoogle Scholar
  8. 8.
    Nelson R, Furner S, Jesudason V (1998) Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum 41:1226–1229PubMedCrossRefGoogle Scholar
  9. 9.
    Al-Mufti R, McCarthy A, Fisk NM (1997) Survey of obstetricians’ personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol 73:1–4PubMedCrossRefGoogle Scholar
  10. 10.
    Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breart G (2006) Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 108:541–548PubMedGoogle Scholar
  11. 11.
    Wu JM, Hundley AF, Visco AG (2005) Elective primary cesarean delivery: attitudes of urogynecology and maternal-fetal medicine specialists. Obstet Gynecol 105:301–306PubMedGoogle Scholar
  12. 12.
    National Institutes of Health (2007) Prevention of fecal and urinary incontinence in adults. NIH, BethesdaGoogle Scholar
  13. 13.
    Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M (2007) Incidence of fecal incontinence after childbirth. Obstet Gynecol 109:281–288PubMedGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention (2007) Pregnancy risk assessment monitory system (PRAMS). Retrieved July 11, 2007, from http://www.cdc.gov/prams/
  15. 15.
    Osterberg A, Graf W, Karlbom U, Pahlman L (1996) Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation. Scand J Gastroenterol 31:575–580PubMedCrossRefGoogle Scholar
  16. 16.
    Reilly WT, Talley NJ, Pemberton JH, Zinsmeister AR (2000) Validation of a questionnaire to assess fecal incontinence and associated risk factors: Fecal incontinence questionnaire. Dis Colon Rectum 43:146–153 (discussion 153–144)PubMedCrossRefGoogle Scholar
  17. 17.
    Hall W, McCracken K, Osterweil P, Guise JM (2003) Frequency and predictors for postpartum fecal incontinence. Am J Obstet Gynecol 188:1205–1207PubMedCrossRefGoogle Scholar
  18. 18.
    Viswanathan M, Visco AG, Hartmann K, Wechter ME, Gartlehner G, Wu JM et al (2006) Cesarean delivery on maternal request. Evidene Report/Technology Assessment No. 133. AHRQ Publication No. 06-E009. Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar
  19. 19.
    Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961PubMedCrossRefGoogle Scholar
  20. 20.
    Fynes M, Donnelly VS, O’Connell PR, O’Herlihy C (1998) Cesarean delivery and anal sphincter injury. Obstet Gynecol 92:496–500PubMedCrossRefGoogle Scholar
  21. 21.
    Lal M, Mann CH, Callender R, Radley S (2003) Does cesarean delivery prevent anal incontinence? Obstet Gynecol 101:305–312PubMedCrossRefGoogle Scholar
  22. 22.
    Borello-France D, Burgio KL, Richter HE, Zyczynski H, Fitzgerald MP, Whitehead W et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872PubMedCrossRefGoogle Scholar
  23. 23.
    Zetterstrom JP, Lopez A, Anzen B, Dolk A, Norman M, Mellgren A (1999) Anal incontinence after vaginal delivery: a prospective study in primiparous women. BJOG 106:324–330CrossRefGoogle Scholar
  24. 24.
    Burgio KL, Borello-France D, Richter HE, Fitzgerald MP, Whitehead W, Handa VL et al (2007) Risk factors for fecal and urinary incontinence after childbirth: the childbirth and pelvic symptoms study. Am J Gastroenterol 102:1998–2004PubMedCrossRefGoogle Scholar
  25. 25.
    Sou SC, Chen WJ, Hsieh WS, Jeng SF (2006) Severe obstetric complications and birth characteristics in preterm or term delivery were accurately recalled by mothers. J Clin Epidemiol 59:429–435PubMedCrossRefGoogle Scholar
  26. 26.
    Waldenstrom U (2003) Women’s memory of childbirth at two months and one year after the birth. Birth 30:248–254PubMedCrossRefGoogle Scholar
  27. 27.
    Elkadry E, Kenton K, White P, Creech S, Brubaker L (2003) Do mothers remember key events during labor? Am J Obstet Gynecol 189:195–200PubMedCrossRefGoogle Scholar
  28. 28.
    Tate AR, Dezateux C, Cole TJ, Davidson L, Millennium Cohort Study Child Health G (2005) Factors affecting a mother’s recall of her baby’s birth weight. Int J Epidemiol 34:688–695PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2008

Authors and Affiliations

  • Jeanne-Marie Guise
    • 1
    • 2
    • 3
    • 5
    Email author
  • Sarah Hamilton Boyles
    • 4
  • Patricia Osterweil
    • 1
  • Hong Li
    • 1
  • Karen B. Eden
    • 2
  • Motomi Mori
    • 3
  1. 1.Department of OB/GYNOregon Health & Science UniversityPortlandUSA
  2. 2.Department of Medical Informatics and Clinical EpidemiologyOregon Health & Science UniversityPortlandUSA
  3. 3.Department of Public Health & Preventive MedicineOregon Health & Science UniversityPortlandUSA
  4. 4.Department of Providence Women and Children’s Health Research CenterProvidence Health & ServicesPortlandUSA
  5. 5.PortlandUSA

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