Delivery and Anal Incontinence: Definition,Classification, Prevalence and Patophysiology

Overview

Objective:
Summary of the mutual relationship between vaginal delivery and anal incontinence.Design: Review.Setting: Department of Gynecology and Obstetric, Charles University and Faculty Hospital Pilsen.Summary: Review of the current international literature covering the given problem. Anal incontinenceis defined as an unvoluntary leakage of flatus, liquid or solid stool. Fecal incontinence meansthe leakage of liquid and solid stool only. Women are at eighttimes higher risk of developing analincontinence (the leakage of flatus, fluid or hard stool). The main reason considered to be the causeof this difference is a birth. Postnatal anal incontinence is a disabling problem for as much as 13-20%of women. Review describes classification, prevalence, incidence and cause of Al in women considering maternal position at birth, second stage of labor, breastfeeding, anal sexual intercourse andmultiple births. Two main pathogenetic mechanisms are presented. 1) Perineal neurological injuryis described in earlier studies. This looks to be themajor reason for 3rd and following vaginal births. 2) Anapparent or occult anal sphincter tear seems to be the main factor particularly for the 1st vaginalbirth. 2.3% of primigravidae have an apparent tear and 35% sonographically detected occult analsphincter tear. Anal incontinence develops nearly exclusively in these groups. 42% of afflictedwomen complain of impaired quality of life. Anal incontinence appears to be improved within thetime (in 36-76%). Longterm outcome is not known yet. The postnatal check-up should also includethe question of de novo developed anal and urine incontinence or impaired sexual health.

Key words:
anal incontinence, fecal incontinence, pelvic floor, perineal trauma, delivery