title: Incidence and risk factors of postpartum anal incontinence: a prospective study of 503 cases.
abstract: BACKGROUND
  Background: Anal incontinence is a devastating functional postpartum complication. it can cause deep deterioration in the quality of life.
  
  
  OBJECTIVE
  To assess the incidence of postpartum anal incontinence (PPAI) and the major risk factors predisposing for it in the short and middle terms.
  
  
  METHODS
  This prospective observational study was conducted in the department of Obstetrics and Gynecology B in the Maternity and Neonatology Center of Tunis between March 1st and july 31st, 2009.
  
  
  RESULTS
  Five hundred and three women were included. PPAI was 4.2% on the fourth day postpartum and 4% between weeks 6 and 8 postpartum. Predisposing factors to 4th day PPAI were forceps delivery (p<0.001), prolonged second stage of labor> 5hours (p=0.047), expulsion phase > 20mn (p<0.001), uterine revision (P=0.001) and first degree perineal lacerations (p<0.001). Between 6 and 8 weeks postpartum, identified risk factors were Shoulder dystocia (p<0.001), anu-vulvar distance < 2cm, perineal scars and transverse abdominal diameter >105mm (p<0.001).
  
  
  CONCLUSIONS
  Preventive measures must be implemented in patients with PPAI risk factors.
authors.forename: Monia
authors.initials: M
authors.lastname: Malek-mellouli
authors.forename: Soulé
authors.initials: S
authors.lastname: Assen
authors.forename: Fethi
authors.initials: F
authors.lastname: Ben Amara
authors.forename: Hamdi
authors.initials: H
authors.lastname: Gada
authors.forename: Kacem
authors.initials: K
authors.lastname: Masmoudi
authors.forename: Hédi
authors.initials: H
authors.lastname: Reziga
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D036861:Delivery, Obstetric / Q000009:adverse effects; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors