title: Natural progression of anal incontinence after childbirth.
abstract: OBJECTIVE
  The aim of work is to study the natural progression of anal incontinence (AI) in women 10 years after their first delivery and to identify risk factors associated with persistent AI.
  
  
  METHODS
  A prospective cohort study of 304 primiparous women with singleton, cephalic delivery giving vaginal childbirth in 1995. Questionnaires distributed and collected at delivery, 9 months, 5 years and 10 years after, assessing anorectal symptoms, subsequent treatment, and obstetrical events.
  
  
  RESULTS
  Women, 246 of 304, answered all questionnaires (81%). Thirty-five of 246 (14%) had a sphincter tear at the first delivery. One hundred ninety-six of 246 (80%) women had additional vaginal deliveries and no caesarean sections. The prevalence of AI at 10 years after the first delivery was 57% in women with a sphincter tear and 28% in women, a nonsignificant increase compared to the 5-year follow-up. Women who sustained a sphincter tear at the first delivery had an increased risk of severe AI (RR 3.9, 95% CI 1.3-11.8). Neither age, nor subsequent deliveries added to the risk. Severe AI at baseline and 5 years after delivery were independently strong predictors of severe AI at 10 years (RR 12.6, CI 3.3-48.3, and RR 8.3, CI 3.9-17.8, respectively).
  
  
  CONCLUSIONS
  Persistent anal incontinence 10 years after the first parturition is frequent and sometimes severe, especially if vaginal delivery was complicated by an anal sphincter disruption.
authors.affiliation: Department of Surgery, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Nordenstam
authors.forename: Daniel
authors.initials: D
authors.lastname: Altman
authors.forename: Sophia
authors.initials: S
authors.lastname: Brismar
authors.forename: Jan
authors.initials: J
authors.lastname: Zetterström
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D018450:Disease Progression; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D011446:Prospective Studies; D012306:Risk