Diseases of the Colon & Rectum

, Volume 39, Issue 8, pp 852–859 | Cite as

Long-term effect of vaginal deliveries on anorectal function in normal perimenopausal women

  • Allan Maltha Ryhammer
  • SØren Laurberg
  • Anne Pernille Hermann
Original Contributions


PURPOSE: This study was undertaken to determine the long-term effects of vaginal deliveries on anorectal function in healthy perimenopausal women. METHODS: An observational study of 144 perimenopausal women living in the county of Aarhus, Denmark, aged 45 to 57 (mean, 50) years were randomly selected from the National Register. All women had delivered 0 to 6 (mean, 2) times 10 to 34 years before the investigation. Examinations describing pelvic floor function were measurements of perineal position at rest and descent during straining, anal mucosa electrosensitivity, maximum resting pressure and maximum squeeze pressure of the anal sphincters, and pudendal nerve terminal motor latency. All tests were performed by one of the authors (AMR) and without knowledge of parity. Data were analyzed using the multiple regression technique, and all associations between anorectal function and parity were corrected for age and hysterectomy status. RESULTS: Increasing parity correlated with a lowered perineal position at rest (correlation coefficient (r)=0.26;P=0.003), an increased descent during straining (r=0.24;P=0.006), an increased threshold of anal mucosa electrosensitivity (r=0.22,P=0.008), and an increased pudendal nerve terminal motor latency on both sides (r=0.27;P=0.002). No effect of parity on the maximum resting pressure (r=0.06;P=0.70) and maximum squeeze pressure (r=0.06;P=0.36) was found. The number of vaginal deliveries account for only a minor fraction of the total variability seen in the tests of pelvic floor function (between 1.6 and 5.7 percent). CONCLUSION: Repeated vaginal deliveries have a long-term adverse effect on anorectal physiology in a population of randomly selected healthy perimenopausal women.

Key words

Parity Vaginal delivery Anorectal function Fecal incontinence etiology Flatus incontinence Clinical study 


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  1. 1.
    Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol 1994;101:22–8.PubMedGoogle Scholar
  2. 2.
    Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993;329:1905–11.PubMedGoogle Scholar
  3. 3.
    Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis 1986;1:20–4.PubMedGoogle Scholar
  4. 4.
    Swash M, Snooks SJ, Henry MM. Unifying concept of pelvic floor disorders and incontinence. J R Soc Med 1985;78:906–11.PubMedGoogle Scholar
  5. 5.
    Sultan AH, Kamm MA, Bartram CI, Hudson CN. Anal sphincter trauma during instrumental delivery. Int J Gynaecol Obstet 1993;43:263–70.PubMedGoogle Scholar
  6. 6.
    Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg 1990;77:1358–60.PubMedGoogle Scholar
  7. 7.
    Jameson JS, Chia YW, Kamm MA, Speakman CT, Chye YH, Henry MM. Effect of age, sex and parity on anorectal function. Br J Surg 1994;81:1689–92.PubMedGoogle Scholar
  8. 8.
    Cali RL, Blatchford GJ, Perry RE, Pitsch RM, Thorson AG, Christensen MA. Normal variation in anorectal manometry. Dis Colon Rectum 1992;35:1161–4.PubMedGoogle Scholar
  9. 9.
    Akervall S, Nordgren S, Fasth S, Oresland T, Pettersson K, Hulten L. The effects of age, gender, and parity on rectoanal functions in adults. Scand J Gastroenterol 1990;25:1247–56.PubMedGoogle Scholar
  10. 10.
    McHugh SM, Diamant NE. Effect of age, gender, and parity on anal canal pressures: contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 1987;32:726–36.PubMedGoogle Scholar
  11. 11.
    Haadem K, Dahlstrom JA, Ling L. Anal sphincter competence in healthy women: clinical implications of age and other factors. Obstet Gynecol 1991;78:823–7.PubMedGoogle Scholar
  12. 12.
    Siroky MB. Interpretation of urinary flow rates. Urol Clin North Am 1990;17:537–42.PubMedGoogle Scholar
  13. 13.
    Taylor BM, Beart RW Jr, Phillips SF. Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology 1984;86:693–7.PubMedGoogle Scholar
  14. 14.
    Henry MM, Parks AG, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg 1982;69:470–2.PubMedGoogle Scholar
  15. 15.
    Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.PubMedGoogle Scholar
  16. 16.
    Rogers J, Henry MM, Misiewicz JJ. Disposable pudendal nerve stimulator: evaluation of the standard instrument and new device. Gut 1988;29:1131–3.PubMedGoogle Scholar
  17. 17.
    Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989;32:737–42.PubMedGoogle Scholar
  18. 18.
    Felt Bersma RJ, Gort G, Meuwissen SG. Normal values in anal manometry and rectal sensation: a problem of range. Hepatogastroenterology 1991;38:444–9.PubMedGoogle Scholar
  19. 19.
    Bannister JJ, Abouzekry L, Read NW. Effect of aging on anorectal function. Gut 1987;28:353–7.PubMedGoogle Scholar
  20. 20.
    Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546–50.PubMedGoogle Scholar
  21. 21.
    Matheson DM, Keighley MR. Manometric evaluation of rectal prolapse and faecal incontinence. Gut 1981;22:126–9.PubMedGoogle Scholar
  22. 22.
    Loening-Baucke V, Anuras S. Anorectal manometry in healthy elderly subjects. J Am Geriatr Soc 1984;32:636–9.PubMedGoogle Scholar
  23. 23.
    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;38:1206–9.PubMedGoogle Scholar
  24. 24.
    Jolleys JV. Reported prevalence of urinary incontinence in women in a general practice. BMJ 1988;296:1300–2.PubMedGoogle Scholar
  25. 25.
    Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B. The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women. J Urol 1993;149:1459–62.PubMedGoogle Scholar
  26. 26.
    Molander U. Urinary incontinence and related urogenital symptoms in elderly women. Acta Obstet Gynecol Scand Suppl 1993;158:1–22.PubMedGoogle Scholar
  27. 27.
    Teasdale TA, Taffet GE, Luchi RJ, Adam E. Urinary incontinence in a community-residing elderly population. J Am Geriatr Soc 1988;36:600–6.PubMedGoogle Scholar
  28. 28.
    Thomas TM, Plymat KR, Blannin J, Meade TW. Prevalence of urinary incontinence. BMJ 1980;281:1243–5.PubMedGoogle Scholar
  29. 29.
    Foldspang A, Mommsen S, Lam GW, Elving L. Parity as a correlate of adult female urinary incontinence prevalence. J Epidemiol Community Health 1992;46:595–600.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1996

Authors and Affiliations

  • Allan Maltha Ryhammer
    • 1
    • 2
  • SØren Laurberg
    • 1
  • Anne Pernille Hermann
    • 3
  1. 1.Surgical Research Unit, Department of Surgery LUniversity Hospital of Aarhus-AmtssygehusetAarhusDenmark
  2. 2.University Department of Endocrinology and Metabolism, AmtssygehusetUniversity Hospital of AarhusAarhusDenmark
  3. 3.Institute of Experimental Clinical ResearchUniversity of AarhusAarhusDenmark

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