Does cesarean delivery prevent anal incontinence?
OBJECTIVE
To compare the incidence and severity of anal incontinence in primiparas after cesarean delivery versus spontaneous vaginal delivery.


METHODS
A total of 184 primiparas who delivered by cesarean (104 emergency, 80 elective) and 100 who delivered vaginally were interviewed 10 +/- 2 months postpartum. A comprehensive bowel function questionnaire was completed. Bowel-specific questions included bowel habits, laxative use, urgency, flatus, urge and passive incontinence, soiling, and pad use, before and during pregnancy and postpartum. Obstetric details were confirmed from obstetric records.


RESULTS
Anal incontinence was first present in nine (5%) mothers after cesarean delivery and eight (8%) after vaginal delivery (relative risk 0.611, 95% confidence interval 0.25, 1.53). Severe symptoms necessitating pad use affected two (3%) mothers after elective cesarean and one (1%) after vaginal delivery. Two (3%) mothers after elective cesarean, one (1%) after emergency cesarean, and two (2%) after vaginal delivery had at least two symptoms. Anal incontinence followed prelabor emergency cesarean in two mothers. Of the 22 mothers who sustained a second-degree tear, five (23%) had new anal incontinence compared with only one (3%) of 40 mothers with an intact perineum (Fisher exact test value = 9.697, P =.014).


CONCLUSIONS
Because severe anal incontinence followed elective and prelabor emergency cesarean, it seems that pregnancy itself can lead to pelvic floor disorders. A high incidence of anal incontinence is associated with a second-degree tear. Measures to detect and reduce postpartum anal incontinence should target all pregnant women and mothers, even after prelabor cesarean delivery.
Lal
Mira
M
Department of Obstetrics and Gynecology, Wordsley Hospital, Dudley Group of Hospitals, National Health Service Trust, Stourbridge, West Midlands, United Kingdom. mira@miralal.freeserve.co.uk
H  Mann
Christopher
C
Callender
Roger
R
Radley
Simon
S
D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods*; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009321:Natural Childbirth; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010298:Parity; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011336:Probability; D012016:Reference Values; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index