title: Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice.
abstract: OBJECTIVE
  To investigate whether postpartum fecal incontinence is less common in women who had a cesarean delivery and more common in women who had an operative vaginal birth compared with women who had a spontaneous vaginal birth for their first newborn, and whether postpartum fecal incontinence is more common in women who report intimate-partner violence.
  
  
  METHODS
  This was a multicenter, prospective, nulliparous pregnancy cohort (n=1,507) using standardized measures to assess frequency and severity of fecal incontinence in pregnancy and at 3, 6, 9, and 12 months postpartum.
  
  
  RESULTS
  Approximately 17% reported fecal incontinence at some point in the first 12 months postpartum, with 12.8% reporting fecal incontinence beyond the first 3 months postpartum. Fecal incontinence at 4 to 12 months postpartum was significantly more common among women who had experienced emotional violence, physical violence, or both in the first 12 months postpartum (18.8% compared with 11.5%, adjusted odds ratio [OR] 1.62, 95% confidence interval [CI] 1.05-2.50). Compared with spontaneous vaginal birth, cesarean delivery (13.1% compared with 11.3%, adjusted OR 0.99, 95% CI 0.65-1.53), and operative vaginal birth (15.0% compared with 11.3%, adjusted OR 1.33, 95% CI 0.86-2.07) did not significantly alter the likelihood of fecal incontinence beyond the first 3 months postpartum.
  
  
  CONCLUSIONS
  Understanding causal pathways for postpartum fecal incontinence requires attention to the interplay of pregnancy and birth events and upstream factors such as intimate-partner violence. This has implications for how clinicians present evidence and discuss risks associated with vaginal birth and cesarean delivery. In this nulliparous cohort, method of birth was not a major determinant of fecal incontinence status beyond 3 months postpartum.
  
  
  METHODS
  II.
authors.affiliation: Healthy Mothers Healthy Families Research Group and the Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia. stephanie.brown@mcri.edu.au
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Brown
authors.forename: Deirdre
authors.initials: D
authors.lastname: Gartland
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.forename: Christine
authors.initials: C
authors.lastname: MacArthur
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D013179:Spouse Abuse / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult