Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study
Article first published online: 10 SEP 2013
© 2013 Royal College of Obstetricians and Gynaecologists
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 121, Issue 3, pages 269–280, February 2014
How to Cite
Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG 2014;121:269–280., , , , , .
- Issue published online: 16 JAN 2014
- Article first published online: 10 SEP 2013
- Manuscript Accepted: 21 JUN 2013
- Norwegian Women's Public Health Association
- Norwegian Extra Foundation for Health and Rehabilitation
- Ostfold Hospital Trust
- St. Olavs Hospital
- Trondheim University Hospital
- Norwegian University of Science and Technology
- Central Norway Regional Health Authority
- Anal incontinence;
- post partum ;
To evaluate the prevalence and predictors of anal incontinence (AI) in late pregnancy and 1 year after delivery.
Prospective population-based cohort study.
Two maternity units in Norway 2009–2010.
Primiparae aged 18 years or over.
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
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).
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.