title: Does a second delivery increase the risk of anal incontinence?
abstract: OBJECTIVE
  To evaluate the prevalence of anal incontinence and anal sphincter defects after a first vaginal delivery and assess the effect of a second delivery.
  
  
  METHODS
  Prospective cohort study using postal questionnaires assessing incontinence to flatus and stools at three and thirty months postnatally and anal endosonography at three months following delivery.
  
  
  METHODS
  Recruitment was from the antenatal clinic at the University Hospitals of Geneva, Switzerland.
  
  
  METHODS
  One hundred women with a vaginal delivery of their first child.
  
  
  METHODS
  Prevalence of anal incontinence and anal sphincter defects.
  
  
  RESULTS
  Anal incontinence was reported by 16/92 (17%) of women at three months after delivery and by 11/77 (14%) at 30 months. At that time, 5/54 (9%) with no further delivery reported incontinence, compared with 6/ 23 (26%) of those who had had another delivery (RR 2.8, 95% CI 1.0-8.3). Anal sphincter defects were diagnosed by endosonography in 46/87 (53%) women and were associated with reported incontinence at both three months (RR 1.9; 95% CI 1.4-2.6) and 30 months (RR 1.9: 95% CI 1.3-2.8) after delivery. The prevalence of anal incontinence at 30 months was highest (5/13, 39%) among those in whom a sphincter defect was diagnosed by endosonography after their first delivery and with a second delivery.
  
  
  CONCLUSIONS
  Anal incontinence after childbirth is associated with defects of the anal sphincter diagnosed by endosonography. Subsequent deliveries increase the risk of incontinence, particularly among women with a sphincter defect diagnosed after the first delivery.
authors.affiliation: Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland.
authors.forename: D L
authors.initials: DL
authors.lastname: Faltin
authors.forename: M R
authors.initials: MR
authors.lastname: Sangalli
authors.forename: B
authors.initials: B
authors.lastname: Roche
authors.forename: L
authors.initials: L
authors.lastname: Floris
authors.forename: M
authors.initials: M
authors.lastname: Boulvain
authors.forename: A
authors.initials: A
authors.lastname: Weil
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001004:Anus Diseases / Q000209:etiology*; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors