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Fecal and Urinary Incontinence in Primiparous Women

From ¹Duquesne University, Pittsburgh, Pennsylvania; ²Birmingham VA Medical Center, Birmingham, Alabama; ³University of Alabama, Birmingham, Alabama; University of Pittsburgh, Pittsburgh, Pennsylvania; Loyola University Medical Center, Maywood, Illinois; University of North Carolina, Chapel Hill, North Carolina; Baylor College of Medicine, Houston, Texas; University of Iowa, Iowa City, Iowa; Johns Hopkins University, Baltimore, Maryland; National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; and University of Michigan, Ann Arbor, Michigan.

OBJECTIVE: To prospectively investigate the relationship between anal sphincter tears and postpartum fecal and urinary incontinence.

METHODS: The Childbirth and Pelvic Symptoms study was a prospective cohort study performed by the Pelvic Floor Disorders Network to estimate the prevalence of postpartum fecal and urinary incontinence in primiparous women: 407 with clinically recognized anal sphincter tears during vaginal delivery, 390 without recognized sphincter tears (vaginal controls), and 124 delivered by cesarean before labor. Women were recruited postpartum while hospitalized and interviewed by telephone 6 weeks and 6 months postpartum. We assessed fecal and urinary incontinence symptoms using the Fecal Incontinence Severity Index and the Medical, Epidemiological, and Social Aspects of Aging Questionnaire, respectively. Odds ratios were adjusted for age, race, and clinical site.

RESULTS: Compared with the vaginal control group, women in the sphincter tear cohort reported more fecal incontinence (6 weeks, 26.6% versus 11.2%; adjusted odds ratio [AOR] 2.8, 95% confidence interval [CI] 1.8–4.3; 6 months, 17.0% versus 8.2%; AOR 1.9, 95% CI 1.2–3.2), more fecal urgency and flatal incontinence, and greater fecal incontinence severity at both times. Urinary incontinence prevalence did not differ between the sphincter tear and vaginal control groups. Six months postpartum, 22.9% of women delivered by cesarean reported urinary incontinence, whereas 7.6% reported fecal incontinence.

CONCLUSION: Women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence than women without sphincter tears. Cesarean delivery before labor is not entirely protective against pelvic floor disorders.

LEVEL OF EVIDENCE: II-3

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