Skip to main content

Advertisement

SpringerLink
Log in

Faecal incontinence 20 years after one birth: a comparison between vaginal delivery and caesarean section

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces—solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20 years after one vaginal (VD) or one caesarean section (CS).

Methods

This was a registry-based national cohort study of primiparae giving birth in 1985–1988 and having no further births (n = 5,236). Data from the Swedish Medical Birth Register were linked to information from a pelvic floor disorder questionnaire in 2008 (response rate 65.2 %). Analysis of variance and multivariate analysis were used to obtain adjusted prevalence and odds ratios (adj-OR).

Results

Overall prevalences of FI and AI were 13.6 and 47.0 %. FI prevalence was higher after VD compared with CS [14.5 versus 10.6 %, adj-OR 1.43, 95 % confidence interval (CI) 1.16–1.77] but was not increased after acute versus elective CS. Perineal tear (≥second degree) increased the prevalence and risk of FI compared with no tear (22.8 versus 13.9 %, adj-OR 1.95, 95 % CI 1.33–2.85). The prevalence of FI was lower after VD with an episiotomy (11.1 %) and similar to that after CS (10.6 %). With each unit increase of current body mass index the odds of FI increased by 6 % (OR 1.06, 95 % CI 1.04–1.08).

Conclusions

Late FI and AI prevalences were higher after VD compared with CS. Perineal tear (≥second degree) versus no tear doubled the prevalence of FI. FI prevalence was similar after a CS and a VD combined with episiotomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Al-Mufti R, McCarthy A, Fisk NM (1997) Survey of obstetricians’ personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol 73:1–4

    Article  PubMed  CAS  Google Scholar 

  2. Nygaard I (2005) Should women be offered elective cesarean section in the hope of preserving pelvic floor function? Int Urogynecol J Pelvic Floor Dysfunct 16:253–254

    Article  PubMed  Google Scholar 

  3. Nelson RL, Furner SE, Westercamp M, Farquhar C (2010) Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2:CD006756

    PubMed  Google Scholar 

  4. Bharucha AE, Zinsmeister AR, Schleck CD, Melton LJ 3rd (2010) Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case-control study in women. Gastroenterology 139:1559–1566

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bharucha AE (2003) Fecal incontinence. Gastroenterology 124:1672–1685

    Article  PubMed  Google Scholar 

  6. Pretlove J, Thompson PJ, Toozs-Hobson PM, Radley S, Khana KS (2008) Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review. BJOG 115:421–434

    Article  PubMed  CAS  Google Scholar 

  7. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I (2013) The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 120(2):144–151

    Article  PubMed  CAS  Google Scholar 

  8. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  9. Rothbarth J, Bemelman WA, Meijerink WJHJ, Stiggelbout AM, Zwinderman AH et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44:67–71

    Article  PubMed  CAS  Google Scholar 

  10. World Health Organization (1996) International classification of diseases, 9th revision, clinical modification (ICD–9–CM). Geneva, Switzerland

  11. Fritel X, Ringa V, Varnoux N, Zins M, Bréart G (2007) Mode of delivery and faecal incontinence at midlife: a study of 2,640 women in the Gazel cohort. Obstet Gynecol 110:31–38

    Article  PubMed  Google Scholar 

  12. Pretlove SJ, Radley S, Toozs-Hobson PM, Thompson PJ, Coomarasamy A, Khan KS (2006) Prevalence of anal incontinence according to age and gender: a systematic review and meta-regression analysis. Int Urogynecol J Pelvic Floor Dysfunct 17:407–417

    Article  PubMed  CAS  Google Scholar 

  13. Erekson EA, Sung VW, Myers DL (2008) Effect of body mass index on the risk of anal incontinence and defecatory dysfunction in women. Am J Obstet Gynecol 198:596.e1–596.e4

    Article  Google Scholar 

  14. Cuicchi D, Lombardi R, Cariani S, Leuratti L, Lecce F, Cola B (2013) Clinical and instrumental evaluation of pelvic floor disorders before and after bariatric surgery in obese women. Surg Obes Relat Dis 9(1):69–75

    Article  PubMed  Google Scholar 

  15. MacArthur C, Glazener C, Lancashire R, Herbison P, Wilson D et al (2011) Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG 118:1001–1007

    Article  PubMed  CAS  Google Scholar 

  16. Pinta TM, Kylänpää ML, Teramo KA, Luukkonen PS (2004) Sphincter rupture and anal incontinence after first vaginal delivery. Acta Obstet Gynecol Scand 83:917–922

    Article  PubMed  Google Scholar 

  17. Snooks SJ, Barnes PR, Swash M (1984) Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry 47:1269–1273

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Laine K, Gissler M, Pirhonen J (2009) Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obstet Gynecol Reprod Biol 146:71–75

    Article  PubMed  Google Scholar 

  19. Samuelsson E, Ladfors L, Wennerholm UB, Gåreberg B, Nyberg K, Hagberg H (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107:926–931

    Article  PubMed  CAS  Google Scholar 

  20. Faltin DL, Otero M, Petignat P, Sangalli MR, Floris LA, Boulvain M et al (2006) Women’s health 18 years after rupture of the anal sphincter during childbirth: I. Fecal incontinence. Am J Obstet Gynecol 194:1255–1259

    Article  PubMed  Google Scholar 

  21. Kamm MA (1994) Obstetric damage and faecal incontinence. Lancet 344:730–733

    Article  PubMed  CAS  Google Scholar 

  22. Voyvodic F, Rieger NA, Skinner S, Schloithe AC, Saccone GT, Sage MR et al (2003) Endosonographic imaging of anal sphincter injury: does the size of the tear correlate with the degree of dysfunction? Dis Colon Rectum 46:735–741

    Article  PubMed  Google Scholar 

  23. Damon H, Henry L, Bretones S, Mellier G, Minaire Y, Mion F (2000) Postdelivery anal function in primiparous females: ultrasound and manometric study. Dis Colon Rectum 43:472–477

    Article  PubMed  CAS  Google Scholar 

  24. Sultan AH, Kettle C (2007) Diagnosis of perineal trauma. In: Sultan AH, Thakar R, Fenner D (eds) Perineal and anal sphincter trauma: diagnosis and clinical management, 1st edn. Springer, London, pp 13–19

    Chapter  Google Scholar 

  25. Groom KM, Paterson-Brown S (2002) Can we improve on the diagnosis of third degree tears? Eur J Obstet Gynecol Reprod Biol 101:19–21

    Article  PubMed  Google Scholar 

  26. Andrews W, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries—myth or reality? BJOG 113:195–200

    Article  PubMed  Google Scholar 

  27. Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN (2005) Outcomes of routine episiotomy: a systematic review. JAMA 293:2141–2148

    Article  PubMed  CAS  Google Scholar 

  28. Räisänen S, Vehviläinen-Julkunen K, Gissler M, Heinonen S (2012) Hospital-based lateral episiotomy and obstetric anal sphincter injury rates: a retrospective population-based register study. Am J Obstet Gynecol 206:347.e1–347.e6

    Article  Google Scholar 

  29. Whitehead WE, Wald A, Norton NJ (2001) Treatment options for fecal incontinence. Dis Colon Rectum 44:131–142

    Article  PubMed  CAS  Google Scholar 

  30. Wheeler TL, Richter HE (2007) Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Curr Opin Obstet Gynecol 19:474–479

    Article  PubMed  Google Scholar 

Download references

Ethical approval

Ethical approval was obtained from the Regional and the National Ethic Review Boards (the Ethics Committee at Sahlgrenska Academy, Gothenburg University, ref no.381-07, 13 August 2007 and the National Board of Health and Welfare, ref no. 34-9148/2007, 26 October 2007).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden

    Maria Gyhagen, Maria Bullarbo, Thorkild F. Nielsen & Ian Milsom

  2. Department of Obstetrics and Gynaecology, Södra Älvsborgs Hospital, Borås, Sweden

    Maria Bullarbo & Thorkild F. Nielsen

  3. Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden

    Maria Gyhagen

Authors
  1. Maria Gyhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Bullarbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thorkild F. Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ian Milsom
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Gyhagen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gyhagen, M., Bullarbo, M., Nielsen, T.F. et al. Faecal incontinence 20 years after one birth: a comparison between vaginal delivery and caesarean section. Int Urogynecol J 25, 1411–1418 (2014). https://doi.org/10.1007/s00192-014-2390-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-014-2390-1

Keywords

Search

Navigation