Faecal incontinence after childbirth.
OBJECTIVE
To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors.


METHODS
A cohort study with information on symptoms collected in home-based interviews and obstetric data from hospital casenotes.


METHODS
Deliveries from a maternity hospital in Birmingham.


METHODS
Nine hundred and six women interviewed a mean of 10 months after delivery.


METHODS
New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency.


RESULTS
Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections.


CONCLUSIONS
Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.
MacArthur
C
C
Department of Public Health and Epidemiology, Medical School, University of Birmingham, Edgbaston, UK.
Bick
D E
DE
Keighley
M R
MR
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D009772:Obstetrical Forceps / Q000009:adverse effects; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D015995:Prevalence; D011379:Prognosis; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects