Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study

Authors

  • HH Johannessen,

    Corresponding author
    1. Department of Physiotherapy, Østfold Hospital Trust, Fredrikstad, Norway
    2. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
    • Correspondence: Dr HH Johannessen, Department of Quality and Research, PO Box 16, Ostfold Hospital Trust, 1603 Fredrikstad, Norway. Email hege.holmo.johannessen@so-hf.no

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  • A Wibe,

    1. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
    2. Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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  • A Stordahl,

    1. Department of Physiotherapy, Østfold Hospital Trust, Fredrikstad, Norway
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  • L Sandvik,

    1. Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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  • B Backe,

    1. Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
    2. Department of Obstetrics, Women's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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  • S Mørkved

    1. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
    2. Department of Research, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Abstract

Objective

To evaluate the prevalence and predictors of anal incontinence (AI) in late pregnancy and 1 year after delivery.

Design

Prospective population-based cohort study.

Setting

Two maternity units in Norway 2009–2010.

Population

Primiparae aged 18 years or over.

Methods

Primiparae answered questions on the St. Mark's score about AI during the last 4 weeks of pregnancy. One year later, the same questionnaires were distributed by postal mail. Socio-economic and delivery-related data were obtained from hospital records.

Main outcome measures

Self-reported AI.

Results

Answers on AI in late pregnancy were obtained from 1571 women, and 1030 responded 1 year later. Twenty-four per cent experienced one and 4.7% experienced three or more AI symptoms in late pregnancy. One year later, this was reduced to 19% and 2.2%, respectively. Multivariate logistic regression analyses were applied. Formed and loose stool incontinence were strongly associated at both time points. The main predictor of AI 1 year after delivery was AI in late pregnancy. Obstetric anal sphincter injury increased the risk of incontinence of stool and flatus (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.7–9.6) after delivery. Urgency was associated with greater age (OR, 1.8; 95% CI, 1.0–3.3) and operative delivery (OR, 2.0; 95% CI, 1.3–2.9).

Conclusion

One in four primiparae experienced AI in late pregnancy. One year later, still one in five suffered from incontinence. Sphincter injury predicted incontinence of stool and flatus, whereas greater age and operative delivery predicted urgency. The identification and adequate follow-up of pregnant women with AI may reduce AI after delivery.

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