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

  • Thomas G. Gray
  • Holly Vickers
  • Swati Jha
  • Georgina L. Jones
  • Steven R. Brown
  • Stephen C. Radley
Review Article


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.


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.


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).


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.


Anal incontinence Faecal incontinence Post-natal Patient-reported outcomes Questionnaires 



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.

Compliance with ethical standards

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.

Supplementary material

192_2018_3819_MOESM1_ESM.docx (29 kb)
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)
192_2018_3819_MOESM2_ESM.docx (28 kb)
Supplementary Table 2 Summary of results for studies using non-validated questionnaires to identify anal incontinence in women after childbirth. (DOCX 28 kb)
192_2018_3819_MOESM3_ESM.docx (90 kb)
Supplementary Table 3 Summary of results for studies using patient interviews to identify faecal incontinence in women after childbirth. (DOCX 89 kb)
192_2018_3819_MOESM4_ESM.docx (70 kb)
Supplementary Table 4 Response rates for different follow-up periods. (DOCX 70 kb)


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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of UrogynaecologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
  2. 2.Leeds Beckett UniversityLeedsUK
  3. 3.Department of Colorectal SurgerySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK

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