Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study.
OBJECTIVE
To investigate the prevalence of persistent and long term postpartum faecal incontinence and associations with mode of first and subsequent deliveries.


METHODS
Longitudinal study.


METHODS
Maternity units in Aberdeen, Birmingham and Dunedin.


METHODS
Four thousand two hundred and fourteen women who returned postal questionnaires three months and six years postpartum.


METHODS
Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery history.


METHODS
Incontinence to bowel motions three months and six years after index birth. For delivery history, the outcome was incontinence only at six years.


RESULTS
The prevalence of persistent faecal incontinence was 3.6%. Almost 90% of these women reported no symptoms before their first birth. The forceps delivery of a first baby was independently predictive of persistent symptoms (OR 2.06, 95% CI 1.40-3.04). A caesarean section first birth was not significantly associated with persistent symptoms (OR 1.07, 95% CI 0.64-1.81). Delivering exclusively by caesarean section also showed no association with subsequent symptoms (OR 1.04, 95% CI 0.72-1.50) but ever having forceps was significantly predictive (OR 1.48, 95% CI 1.18-1.87). Other factors independently associated with persistent faecal incontinence were older maternal age, increasing number of births and Asian ethnic group. Birthweight and long second stage were not significantly associated.


CONCLUSIONS
The risk of persistent faecal incontinence is significantly higher after a first delivery by forceps. We found no evidence of a lower risk of subsequent faecal incontinence for exclusive caesarean section deliveries.
Macarthur
Christine
C
University of Birmingham, UK.
Glazener
Charis
C
Lancashire
Robert
R
Herbison
Peter
P
Wilson
Don
D
Grant
Adrian
A
D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008423:Maternal Age; D009520:New Zealand / Q000453:epidemiology; D009772:Obstetrical Forceps / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology