title: Women's health 18 years after rupture of the anal sphincter during childbirth: I. Fecal incontinence.
abstract: OBJECTIVE
  We studied the long-term outcome after an anal sphincter tear.
  
  
  METHODS
  From a cohort of 4569 women who gave birth in 1982 to 1983, we identified 445 (9.7%) who sustained a sphincter tear and 445 controls. Eighteen years after the delivery, we mailed them a questionnaire and graded fecal incontinence with the Wexner score, a summary of incontinence to flatus, liquid, or solid stools; need to wear a pad; and lifestyle alterations. We predefined severe incontinence as a score above 4 of 20.
  
  
  RESULTS
  Five hundred forty of 890 women (61%) returned the questionnaire. Severe fecal incontinence was reported by 34 of 259 women (13.1%) after a sphincter tear and 22 of 281 controls (7.8%) (risk ratio 1.7, 95% confidence interval 1.0 to 2.8). Only 6.4% of the reports of fecal incontinence were attributable to a sphincter tear.
  
  
  CONCLUSIONS
  Fecal incontinence is frequently reported, even by women who have not sustained an anal sphincter tear. Only a small fraction of fecal incontinence can be attributed to sphincter tears.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Geneva, Geneva, Switzerland. daniel.faltin@hcuge.ch
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Faltin
authors.forename: Maria
authors.initials: M
authors.lastname: Otero
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
authors.forename: Michel R
authors.initials: MR
authors.lastname: Sangalli
authors.forename: Lucia A
authors.initials: LA
authors.lastname: Floris
authors.forename: Michel
authors.initials: M
authors.lastname: Boulvain
authors.forename: Olivier
authors.initials: O
authors.lastname: Irion
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D016022:Case-Control Studies; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D036801:Parturition; D011247:Pregnancy; D012421:Rupture / Q000150:complications; D011795:Surveys and Questionnaires