title: Fecal and urinary incontinence in primiparous women.
abstract: OBJECTIVE
  To prospectively investigate the relationship between anal sphincter tears and postpartum fecal and urinary incontinence.
  
  
  METHODS
  The Childbirth and Pelvic Symptoms study was a prospective cohort study performed by the Pelvic Floor Disorders Network to estimate the prevalence of postpartum fecal and urinary incontinence in primiparous women: 407 with clinically recognized anal sphincter tears during vaginal delivery, 390 without recognized sphincter tears (vaginal controls), and 124 delivered by cesarean before labor. Women were recruited postpartum while hospitalized and interviewed by telephone 6 weeks and 6 months postpartum. We assessed fecal and urinary incontinence symptoms using the Fecal Incontinence Severity Index and the Medical, Epidemiological, and Social Aspects of Aging Questionnaire, respectively. Odds ratios were adjusted for age, race, and clinical site.
  
  
  RESULTS
  Compared with the vaginal control group, women in the sphincter tear cohort reported more fecal incontinence (6 weeks, 26.6% versus 11.2%; adjusted odds ratio [AOR] 2.8, 95% confidence interval [CI] 1.8-4.3; 6 months, 17.0% versus 8.2%; AOR 1.9, 95% CI 1.2-3.2), more fecal urgency and flatal incontinence, and greater fecal incontinence severity at both times. Urinary incontinence prevalence did not differ between the sphincter tear and vaginal control groups. Six months postpartum, 22.9% of women delivered by cesarean reported urinary incontinence, whereas 7.6% reported fecal incontinence.
  
  
  CONCLUSIONS
  Women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence than women without sphincter tears. Cesarean delivery before labor is not entirely protective against pelvic floor disorders.
  
  
  METHODS
  II-3.
authors.affiliation: Duquesne University, Department of Physical Therapy, Pittsburgh, Pennsylvania 15282, USA. borellofrance@duq.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Borello-France
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Burgio
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Halina
authors.initials: H
authors.lastname: Zyczynski
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Fitzgerald
authors.forename: William
authors.initials: W
authors.lastname: Whitehead
authors.forename: Paul
authors.initials: P
authors.lastname: Fine
authors.forename: Ingrid
authors.initials: I
authors.lastname: Nygaard
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Handa
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Visco
authors.forename: Anne M
authors.initials: AM
authors.lastname: Weber
authors.forename: Morton B
authors.initials: MB
authors.lastname: Brown
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D004841:Episiotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005414:Flatulence / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D022125:Lacerations / Q000150:complications*; D010298:Parity; D010502:Perineum / Q000293:injuries; D049590:Postpartum Period; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology