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Natural progression of anal incontinence after childbirth

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Abstract

Introduction and hypothesis

The aim of work is to study the natural progression of anal incontinence (AI) in women 10 years after their first delivery and to identify risk factors associated with persistent AI.

Methods

A prospective cohort study of 304 primiparous women with singleton, cephalic delivery giving vaginal childbirth in 1995. Questionnaires distributed and collected at delivery, 9 months, 5 years and 10 years after, assessing anorectal symptoms, subsequent treatment, and obstetrical events.

Results

Women, 246 of 304, answered all questionnaires (81%). Thirty-five of 246 (14%) had a sphincter tear at the first delivery. One hundred ninety-six of 246 (80%) women had additional vaginal deliveries and no caesarean sections. The prevalence of AI at 10 years after the first delivery was 57% in women with a sphincter tear and 28% in women, a nonsignificant increase compared to the 5-year follow-up. Women who sustained a sphincter tear at the first delivery had an increased risk of severe AI (RR 3.9, 95% CI 1.3–11.8). Neither age, nor subsequent deliveries added to the risk. Severe AI at baseline and 5 years after delivery were independently strong predictors of severe AI at 10 years (RR 12.6, CI 3.3–48.3, and RR 8.3, CI 3.9–17.8, respectively).

Conclusion

Persistent anal incontinence 10 years after the first parturition is frequent and sometimes severe, especially if vaginal delivery was complicated by an anal sphincter disruption.

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Funding

The study was supported by hospital-administered clinical research funds.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden

    Johan Nordenstam

  2. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Johan Nordenstam

  3. Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden

    Daniel Altman, Sophia Brismar & Jan Zetterström

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Daniel Altman

  5. Department of Obstetrics and Gynaecology, Danderyd Hospital, S-182 88, Stockholm, Sweden

    Jan Zetterström

Authors
  1. Johan Nordenstam
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  2. Daniel Altman
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  3. Sophia Brismar
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  4. Jan Zetterström
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Corresponding author

Correspondence to Jan Zetterström.

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Nordenstam, J., Altman, D., Brismar, S. et al. Natural progression of anal incontinence after childbirth. Int Urogynecol J 20, 1029–1035 (2009). https://doi.org/10.1007/s00192-009-0901-2

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  • DOI: https://doi.org/10.1007/s00192-009-0901-2

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