title: Faecal incontinence persisting after childbirth: a 12 year longitudinal study.
abstract: OBJECTIVE
  To investigate persistent faecal incontinence (FI) 12 years after birth and association with delivery mode history and quality of life.
  
  
  METHODS
  Twelve-year longitudinal study.
  
  
  METHODS
  Maternity units in Aberdeen, Birmingham and Dunedin.
  
  
  METHODS
  Women who returned questionnaires 3 months and 12 years after index birth.
  
  
  METHODS
  Data on all births over 12 months were obtained from units and women were contacted 3 months, 6 years and 12 years post birth.
  
  
  METHODS
  Persistent FI, defined as reported at 12 years and one or more previous contacts. SF12 assessed quality of life.
  
  
  RESULTS
  Of 7879 women recruited at 3 months, 3763 responded at 12 years, 2944 of whom also responded at 6 years: nonresponders were similar in obstetric factors. Prevalence of persistent FI was 6.0% (227/3763); 43% of 12-year responders who reported FI at 3 months also reported it at 12 years. Women with persistent FI had significantly lower SF12 scores. Compared with only spontaneous vaginal deliveries, women who had one or more forceps delivery were more likely to have persistent FI (odds ratio [OR] 2.08, 95% confidence interval [95% CI] 1.53-2.85) but it was no less likely with exclusively caesarean births (OR 0.93, 95% CI 0.54-1.58). More obese women than normal weight women reported persistent FI (OR 1.52, 95% CI 1.06-2.17).
  
  
  CONCLUSIONS
  This longitudinal study has demonstrated persistence of FI many years after birth and shown that one forceps birth increased the likelihood, whereas exclusive caesarean birth showed no association. Obesity, which increased symptom likelihood, is a modifiable risk factor.
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Herbison
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lancashire
authors.affiliation: NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hagen
authors.affiliation: Birmingham Women's Hospital, Birmingham Women's NHS Foundation Trust, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Toozs-Hobson
authors.affiliation: Department of Obstetrics and Gynaecology, York Hospital, York, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dean
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: C
authors.initials: C
authors.lastname: Glazener
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002908:Chronic Disease; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009765:Obesity / Q000150:complications; D036801:Parturition; D011247:Pregnancy; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology