Fecal and urinary incontinence in primiparous women.
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.
Borello-France
Diane
D
Duquesne University, Department of Physical Therapy, Pittsburgh, Pennsylvania 15282, USA. borellofrance@duq.edu
Burgio
Kathryn L
KL
Richter
Holly E
HE
Zyczynski
Halina
H
Fitzgerald
Mary Pat
MP
Whitehead
William
W
Fine
Paul
P
Nygaard
Ingrid
I
Handa
Victoria L
VL
Visco
Anthony G
AG
Weber
Anne M
AM
Brown
Morton B
MB
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