Anal function: effect of pregnancy and delivery.
OBJECTIVE
To investigate the effect of pregnancy and delivery on anal continence, sensation, manometry, and sphincter integrity.


METHODS
Two hundred eighty-six nulliparous women in the third trimester completed a symptom questionnaire and underwent anorectal sensation and manometric evaluations. Three months postpartum, 161 women returned and the questionnaires and investigations were repeated together with anal endosonographic examinations.


RESULTS
The prevalence of fecal urgency before, during, and after pregnancy was 1%, 9.4%, and 10.5%, respectively; the prevalence of anal incontinence before, during, and after pregnancy was 1.4%, 7.0%, and 8.7%, respectively. Vaginal delivery, particularly instrumental, resulted in a decrease in anal squeeze pressures (P =.015) and resting pressures (P =.002) but had no effect on anal sensation. Postpartum anal endosonographic examination revealed sphincter disruption in 38% of women. There was no relationship between symptoms and anal manometry, sensation, or sphincter integrity. Vaginal delivery (P <.0001) and perineal trauma (P <.001) were significantly associated with sphincter defects.


CONCLUSIONS
Vaginal delivery is associated with a decrease in anal pressures and increased anal sphincter trauma but has no effect on anal sensation. These changes were not related to anal symptoms.
Chaliha
C
C
Urogynaecology Unit, St George's Hospital, London, United Kingdom.
Sultan
A H
AH
Bland
J M
JM
Monga
A K
AK
Stanton
S L
SL
D001003:Anal Canal / Q000293:injuries / Q000294:innervation / Q000503:physiopathology*; D001004:Anus Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D002585:Cesarean Section / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005414:Flatulence; D006801:Humans; D008365:Manometry; D049590:Postpartum Period; D011247:Pregnancy; D011312:Pressure; D011446:Prospective Studies; D012307:Risk Factors; D012677:Sensation; D011795:Surveys and Questionnaires; D014463:Ultrasonography