Vaginal Birth in Primiparas and Anal Incontinence

Overview

Structured AbstractObjective:
An investigation of incidence and degree of anal incontinence after vaginal deliveryamong primiparas and characterizing of the risk factors.Design: Prospective observational study.Setting: Department of Gynecology and Obstetrics, Charles University and Faculty Hospital Pilsen.Methods: 346 primiparas after consecutive vaginal delivery between May 2000 and February 2001were included. All delivered in lithotomy position. Questionnaires were sent few days after deliveryand then two and 6 - 9 months later. Analysis of the returned questionnaires. 28 obstetric parametersassessed.Results: 46.5% women responded. 23 women registered leakage of flatus before delivery.Twomonthspostpartum one (0.6%) patient reported fecal incontinence and 22 (14.3%) flatus incontinence denovo or impaired already present incontinence. 6 - 9 months after delivery the same patient (0.6%)reported fecal incontinence and 16 women (10.4%) incontinence of flatus. Ten of them felt impairedquality of life. Anal incontinence gradually improved during the time (in 76%). Risk factors ofdeveloping (worsening) of anal incontinence were antenatal anal incontinence (in two monthsperiod) and women weight (or BMI) measured at 6 - 9 months after birth. None of nine patients afterforceps delivery (Breus traction forceps) which responded reported signs of anal incontinence.Neither the range of episiotomy nor the length of perineum had any relation to the development ofanal incontinence. However episiotomy has been shown to be a protective factor of 3rd degree tearin primiparas (RR 0.24). Third degree tear was diagnosed in seven cases (2%), three out of 6 womenreported anal incontinence postpartum.Conclusion: This study shows relatively frequent development of flatus incontinence after vaginaldelivery in primiparas. These symptoms usually improve within the time. Only minimum of womenafter vaginal delivery suffers of fecal incontinence. 42% of women with anal incontinence feelimpaired quality of life. At the first postpartum check every woman should be asked, whether shehas any symptoms of anal or urine incontinence or impaired sexual health. If positive the answer,the woman should get information where to find a help.

Key words:
vaginal birth, anal incontinence, fecal incontinence, episiotomy, perineal injury, forceps