title: Mode of delivery and fecal incontinence at midlife: a study of 2,640 women in the Gazel cohort.
abstract: OBJECTIVE
  To estimate obstetric risk factors of fecal incontinence among middle-aged women.
  
  
  METHODS
  We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61 years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors.
  
  
  RESULTS
  Prevalence of fecal incontinence in the past 12 months was 9.5% (250). Significant risk factors for fecal incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0), self-reported depression (OR 2.1, 95% CI 1.6-2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25-30, 95% CI 1.1-2.0; OR 1.6 for BMI more than 30, 95% CI 1.1-2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0-6.1), and anal surgery (OR 1.7, 95% CI 1.1-2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively).
  
  
  CONCLUSIONS
  In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.
authors.affiliation: Institut national de la santé et de la recherche médicale (INSERM), UMR S149, IFR69, Epidemiological Research on Perinatal Health and Women's Health, Villejuif, France. x-fritel@chd-fguyon.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
authors.forename: Virginie
authors.initials: V
authors.lastname: Ringa
authors.forename: Noëlle
authors.initials: N
authors.lastname: Varnoux
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
mesh_terms: D015331:Cohort Studies; D036861:Delivery, Obstetric; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D010298:Parity; D036801:Parturition; D017773:Pelvic Floor / Q000002:abnormalities / Q000293:injuries; D011247:Pregnancy; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors