title: The association between late-onset fecal incontinence and obstetric anal sphincter defects.
abstract: OBJECTIVE
  Endoanal ultrasonographic results have demonstrated that clinically occult anal sphincter damage during vaginal delivery is common. This may or may not be associated with postpartum fecal incontinence (FI). Bayesian meta-analysis of the literature revealed that at least two thirds of obstetric sphincter disruptions are asymptomatic in the postpartum period. Women with postpartum asymptomatic sphincter damage may be at increased risk for FI with aging compared with those without sphincter injury.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  After excluding patients with other possible causes of FI, the histories of 124 consecutive women with late-onset FI after vaginal delivery were analyzed.
  
  
  METHODS
  Endoanal ultrasonographic findings, pudendal nerve terminal motor latency assessment, and anal manometric results.
  
  
  RESULTS
  Eighty-eight women (71%) with a median of 3 vaginal deliveries had sphincter defects on endoanal ultrasonographic results. The mean incontinence score, squeeze and resting pressures, median age at last delivery, and median duration of FI were not significantly different between patients with and without sphincter defects. Pudendal neuropathy was more frequent in patients without sphincter defects (10 [30.3%], left side; 12 [36.4%], right side) than in patients with sphincter defects (12 [14.3%] and 16 [19.3%], respectively), with the difference nearly reaching statistical significance (P =.054 and P =.059, respectively). The median age at onset of FI in patients with a sphincter defect was 61.5 years vs 68.0 years in those without a sphincter defect, which was not statistically significant (P =.08).
  
  
  CONCLUSIONS
  Analysis of the current patient population revealed that 88 women (71%) with late-onset FI after vaginal delivery had an anatomical sphincter defect. Thus, FI related to anal sphincter defects is likely to occur even in an elderly population who had experienced vaginal deliveries earlier in life.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA. mcderme@ccf.org
authors.forename: Michael
authors.initials: M
authors.lastname: Oberwalder
authors.forename: Adam
authors.initials: A
authors.lastname: Dinnewitzer
authors.forename: M Khurrum
authors.initials: MK
authors.lastname: Baig
authors.forename: Klaus
authors.initials: K
authors.lastname: Thaler
authors.forename: Kathy
authors.initials: K
authors.lastname: Cotman
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: Eric G
authors.initials: EG
authors.lastname: Weiss
authors.forename: Jonathan
authors.initials: J
authors.lastname: Efron
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Vernava
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000294:innervation / Q000502:physiology; D001004:Anus Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D003943:Diagnostic Techniques, Neurological; D019160:Endosonography; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors