Residents' Papers Gynecology
Frequency and predictors for postpartum fecal incontinence,☆☆

https://doi.org/10.1067/mob.2003.333Get rights and content

Abstract

Objective: The goal of this study was to describe the frequency of postpartum fecal incontinence and to examine associated delivery events in a group of women participating in a validation study of a postpartum fecal incontinence survey. Study Design: A self-administered survey of fecal incontinence symptoms and delivery events was administered to 50 women seen for their 6-week postpartum appointments. An analysis of association between postpartum fecal incontinence and individual delivery characteristics was performed. Results: The frequency of at least one fecal incontinence symptom post partum was 38%. Specifically, 24% of women reported incontinence to flatus and 10% incontinence to stool. Vaginal delivery and perineal laceration were associated with an increased risk of reporting at least one symptom. Neither infant birth weight nor parity was associated with an increased risk of postpartum fecal incontinence. Cesarean delivery was associated with a lower frequency of overall fecal incontinence symptoms. Conclusion: The frequency of postpartum fecal incontinence was higher than previously reported. Similar to other studies, perineal laceration, especially extension into the anal sphincter, was an important risk factor for postpartum fecal incontinence. (Am J Obstet Gynecol 2003;188:1205-7.)

Section snippets

Material and methods

A 1-page self-administered questionnaire was completed by women seen in the Oregon Health and Sciences University hospital (OHSU) outpatient clinics for the 6-week postpartum visit. Fifty-two women were approached to participate, and 50 women chose to participate. The study was approved by the OHSU institutional review board.

The survey, available in English and Spanish, contained 30 questions about delivery events, fecal incontinence symptoms, and patient characteristics. Questions about

Results

Among the 50 participants, the average age was 27 years (range 18-40 years), median parity was 1 (range 1-4), and median postpartum status was 6 weeks (range 2-16 weeks). Thirty-seven of the 50 women (74%) had vaginal deliveries, 3 (6%) had operative deliveries, and 10 (20%) had cesarean deliveries (2 without labor, 7 with labor but no pushing, 1 after labor and pushing). Twenty-eight of 48 women (58%) reported a perineal laceration requiring repair, specifically 3 (16%) reported a laceration

Comment

The frequency of fecal incontinence was 38% in the postpartum period. This frequency is higher than what has been reported in previous studies4, 5, 6, 7, 8 and may reflect the inclusion of incontinence of flatus, one-time instances, and events that are exclusively related to intercourse. It is important to consider each of these items as all may have profound impact for patients.

As shown in other studies, a perineal laceration of any type was the most significant delivery event associated with

References (9)

  • C MacArthur et al.

    Obstetric practice and faecal incontinence three months after delivery

    Br J Obstet Gynaecol

    (2001)
  • AM Weber et al.

    The standardization of terminology for researchers in female pelvic floor disorders

    Int Urogynecol J

    (2001)
  • R Nelson et al.

    Fecal incontinence in Wisconsin nursing homes: prevalence and associations

    Dis Colon Rectum

    (1998)
  • P Denis et al.

    Prevalence of anal incontinence in adults

    Gastroenterol Clin Biol

    (1992)
There are more references available in the full text version of this article.

Cited by (53)

  • Internal anal sphincter: Clinical perspective

    2017, Surgeon
    Citation Excerpt :

    Obstetric anal sphincter injuries during childbirth have long been recognised as a leading cause of faecal incontinence. About 13–25% of women report some form of anal incontinence three to six month after vaginal or caesarean delivery24,25 with the prevalence falling to 1–6% by 12 months.26,27 Patients can suffer a range of symptoms including flatus incontinence, passive soiling, or frank incontinence of stools.

  • Sphincter Disturbances

    2014, Encyclopedia of the Neurological Sciences
  • Characterization of colorectal symptoms in women with vesicovaginal fistulas

    2012, International Journal of Gynecology and Obstetrics
    Citation Excerpt :

    The prevalence of FI symptoms in this group of patients is lower than expected given the extensive damage to their anterior pelvis from prolonged obstructed labor. The prevalence of FI and AI in postpartum women in the USA ranges from 10%–18% and 24%–29%, respectively [14–16]. Thus the prevalence of symptoms in women with VVF is lower than rates reported in the USA where prolonged labor and VVF are much less common.

View all citing articles on Scopus

Supported by National Institutes of Health, National Institute for Child Health and Development grant No. 5R01HD41139-02.

☆☆

Reprints not available from the authors.

View full text