title: [Management of postpartum anal incontinence: A systematic review].
abstract: OBJECTIVE
  To analyse the prevalence of postpartum anal incontinence, its risk factors, and its management.
  
  
  METHODS
  A comprehensive systematic review of the literature on PubMed, Medline, Embase and Cochrane using: postpartum anal incontinence, postpartum fecal incontinence, perineal rehabilitation, anal surgery.
  
  
  RESULTS
  The prevalence of postpartum anal incontinence varied from 4% (primipare) to 39% (multipare) at 6 weeks postpartum, whereas fecal incontinence can reach respectively 8 to 12% 6 years after delivery. Identified risk factors were: vaginal delivery (OR: 1.32 [95%CI: 1.04-1.68]) compared to cesarean section, instrumental extractions (OR: 1.47 [95%CI: 1.22-1.78]) compared to spontaneous vaginal delivery but it was only with forceps (OR: 1.50 [95%CI: 1.19-1.89]) and not with vaccum (OR: 1.31 [95%CI: 0.97-1.77]). Maternal age over 35 years (OR: 6 [95%CI: 1.85-19.45]), number of births (3 births: OR: 2.91 [95%CI: 1.32-6.41]) and the occurrence of anal-sphincter injury (OR: 2.3 [95%CI: 1.1-5]) were associated with an increased risk of anal incontinence regardless of the type of delivery compared to a group of women without anal incontinence. Perineal rehabilitation should be interpreted with caution because of the lack of randomized controlled trials. A reassessment at 6 months postpartum in order to propose a surgical treatment by sphincteroplasty could be considered if symptoms persist. The results of the sphincteroplasty were satisfactory but with a success rate fading in time (60 to 90% at 6 months against 50 to 40% at 5 and 10 years).
  
  
  CONCLUSIONS
  Postpartum anal incontinence requires special care. Recommendations for the management of postpartum anal incontinence would be useful.
authors.affiliation: Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre-and-Marie-Curie, 4, rue de la Chine, 75020 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Villot
authors.affiliation: Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre-and-Marie-Curie, 4, rue de la Chine, 75020 Paris, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: G
authors.initials: G
authors.lastname: Demoulin
authors.affiliation: Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Rivain
authors.affiliation: Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: C
authors.initials: C
authors.lastname: Trichot
authors.affiliation: Service de gynécologie-obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN, Group of Clinical Research in Neuro-Urology, University Pierre-and-Marie-Curie, 4, rue de la Chine, 75020 Paris, France. Electronic address: thibault.thubert@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Thubert
mesh_terms: D000465:Algorithms; D005242:Fecal Incontinence / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D015995:Prevalence; D011322:Primary Prevention; D011644:Puerperal Disorders / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D055502:Secondary Prevention
keywords: Fecal incontinence; Incontinence anale; Incontinence fécale du post-partum; Perineal rehabilitation; Postpartum fecal incontinence; Prise en charge chirurgicale; Rééducation périnéale; Surgical management