title: Anal incontinence among first time mothers - what happens in pregnancy and the first year after delivery?
abstract: BACKGROUND
  Pregnancy- and delivery-related factors affect postpartum anal incontinence. We aimed to explore changes in continence status among primiparas from late pregnancy through the first year postpartum.
  
  
  METHODS
  In this prospective cohort study set in two Norwegian hospitals, 862 healthy primiparas completed questionnaires about the main outcome measure anal incontinence, including flatus incontinence and urgency, at three time points; late pregnancy, 6 and 12 months postpartum. Socioeconomic and delivery-related data were obtained from hospital records. Logistic regression analyses were applied to determine the association between continence status at 12 months postpartum, and continence status in late pregnancy, 6 months postpartum, demographic and delivery-related characteristics.
  
  
  RESULTS
  Among the 189 (22%) primiparas reporting anal incontinence in late pregnancy, 34 (18%) had persistent anal incontinence 1 year later. Forty-eight (43%) of the 113 women incontinent at 6 months postpartum experienced persistent anal incontinence at 12 months. Eight percent of previously continent women reported new onset anal incontinence at 6 and 12 months after delivery. Occipitoposterior presentation was the only delivery-related factor increasing the risk of postpartum anal incontinence [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.0-3.4]. Young age increased the risk of anal incontinence at 1 year after delivery, whereas incontinence in late pregnancy increased the risk of anal incontinence persisting through 6 and 12 months postpartum.
  
  
  CONCLUSIONS
  In most first-time mothers with postpartum anal incontinence, the onset of anal incontinence was before delivery. Except for occipitoposterior presentation, no delivery-related factors increased the risk of postpartum anal incontinence. This may indicate that hormonal, mechanical or neuromuscular changes in pregnancy affect long-term anal incontinence more than vaginal delivery.
authors.affiliation: Department of Physiotherapy, Østfold Hospital Trust, Fredrikstad, Norway.|Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Hege Hølmo
authors.initials: HH
authors.lastname: Johannessen
authors.affiliation: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Wibe
authors.affiliation: Department of Surgery, Østfold Hospital Trust, Fredrikstad, Norway.
authors.forename: Arvid
authors.initials: A
authors.lastname: Stordahl
authors.affiliation: Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.|Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Siv
authors.initials: S
authors.lastname: Mørkved
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D009664:Norway; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Anal incontinence; postpartum; pregnancy