title: Prevalence and severity of anal incontinence in women with and without additional vaginal deliveries after a fourth-degree perineal laceration.
abstract: OBJECTIVE
  The aim of this study was to compare the prevalence and severity of anal incontinence among women who had undergone no, one, or at least two additional vaginal deliveries after sustaining a fourth-degree sphincter tear as a nullipara.
  
  
  METHODS
  We conducted a telephone survey to determine our subjects' anal function. The incontinence score was determined by adding the content (flatus, liquid, and solid stool = 1, 2, and 3 points, respectively) and frequency (less than weekly, weekly, and daily = 1, 2, and 3 points, respectively) points. Severe incontinence is defined as having a score of 5 or 6 points and the incontinence having a severe effect on the subject's daily activities.
  
  
  RESULTS
  Of the 148 women interviewed, 52 had undergone zero (Group 1), 60 had had one (Group 2), and 36 had had at least two (Group 3) additional vaginal deliveries. Among the three groups, 20 of 52 (38 percent), 14 of 60 (23 percent), and 10 of 36 (28 percent), respectively, reported anal incontinence (P = 0.208). The proportion that had 1 or 2 points (8/20, 4/14, and 3/10, respectively, P = 0.75) and 3 or 4 points (10/20, 9/14, and 2/10, respectively, P = 0.097) was similar among the three groups. Two of 20 (10 percent), 1 of 14 (7 percent), and 5 of 10 (50 percent), respectively, had a score of 5 or 6 points (P = 0.012). For the three groups, 0 of 20, 0 of 14, and 4 of 10 (40 percent) reported that their incontinence had a severe effect on their daily activities (P = <0.001), and 0 of 52, 0 of 60, and 4 of 36 (11 percent) had severe incontinence (P = 0.002).
  
  
  CONCLUSIONS
  The proportion that had severe incontinence was significantly higher among women who had undergone at least two additional deliveries.
authors.affiliation: Department of Obstetrics and Gynecology, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA. eddie.sze@yale.edu
authors.forename: Eddie H M
authors.initials: EH
authors.lastname: Sze
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index