title: The dual influences of age and obstetric history on fecal continence in parous women.
abstract: OBJECTIVE
  To assess whether women who underwent forceps delivery were more likely than those who delivered either normally (spontaneous vaginal delivery [SVD]) or by cesarean to experience deterioration in fecal continence as they aged.
  
  
  METHODS
  The study investigated fecal continence assessment among women who gave birth to their first child 10, 20, or 30 years previously. Women who had undergone forceps delivery in the selected years were matched with women who had SVD in the same year. Two additional cohorts (1 premenopausal, 1 postmenopausal), who had only ever delivered by pre-labor cesarean, were identified for comparison.
  
  
  RESULTS
  Of the 85 women who participated, 36 had undergone forceps delivery, 35 SVD, and 14 cesarean delivery only. The mode of vaginal delivery had no significant effect on continence scores or manometry pressures. Premenopausal women who had undergone cesarean delivery had significantly higher manometry pressures than those who delivered vaginally, but this protective effect was lost after the menopause. Multivariate analysis of pudendal nerve conduction found that the adverse effect of duration since delivery was greater than the adverse effect of forceps compared with vaginal delivery.
  
  
  CONCLUSIONS
  Mode of delivery and aging affect pelvic floor function. Women who deliver via cesarean are not immune to age-related deterioration of anal sphincter function.
authors.affiliation: Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: Maeve
authors.initials: M
authors.lastname: Eogan
authors.forename: Conor
authors.initials: C
authors.lastname: O'Brien
authors.forename: Leslie
authors.initials: L
authors.lastname: Daly
authors.forename: Michael
authors.initials: M
authors.lastname: Behan
authors.forename: P Ronan
authors.initials: PR
authors.lastname: O'Connell
authors.forename: Colm
authors.initials: C
authors.lastname: O'Herlihy
mesh_terms: D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000293:injuries; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005113:Extraction, Obstetrical / Q000009:adverse effects* / Q000379:methods; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D015999:Multivariate Analysis; D009772:Obstetrical Forceps; D010298:Parity; D017773:Pelvic Floor / Q000293:injuries; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors