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Does a second delivery increase the risk of anal incontinence?

  1. Daniel L. Faltin1,*,
  2. Michel R. Sangalli1,3,
  3. Bruno Roche2,
  4. Lucia Floris1,
  5. Michel Boulvain1,
  6. Antoine Weil1

Article first published online: 22 DEC 2003

DOI: 10.1111/j.1471-0528.2001.00185.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 108, Issue 7, pages 684–688, July 2001

Additional Information

How to Cite

Faltin, D. L., Sangalli, M. R., Roche, B., Floris, L., Boulvain, M. and Weil, A. (2001), Does a second delivery increase the risk of anal incontinence?. BJOG: An International Journal of Obstetrics & Gynaecology, 108: 684–688. doi: 10.1111/j.1471-0528.2001.00185.x

Author Information

  1. 1

    Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland

  2. 2

    Department of Surgery, University Hospitals of Geneva, Switzerland

  3. 3

    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, The Canberra Hospital, Australia

**Dr D. L. Faltin, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.

Publication History

  1. Issue published online: 22 DEC 2003
  2. Article first published online: 22 DEC 2003
  3. Accepted 22 February 2001

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Objective To evaluate the prevalence of anal incontinence and anal sphincter defects after a first vaginal delivery and assess the effect of a second delivery.

Design Prospective cohort study using postal questionnaires assessing incontinence to flatus and stools at three and thirty months postnatally and anal endosonography at three months following delivery.

Setting Recruitment was from the antenatal clinic at the University Hospitals of Geneva, Switzerland.

Population One hundred women with a vaginal delivery of their first child.

Mainoutcome measures Prevalence of anal incontinence and anal sphincter defects.

Results Anal incontinence was reported by 16/92 (17%) of women at three months after delivery and by 11/77 (14%) at 30 months. At that time, 5/54 (9%) with no further delivery reported incontinence, compared with 6/23 (26%) of those who had had another delivery (RR 2.8, 95% CI 1.0-8.3). Anal sphincter defects were diagnosed by endosonography in 46/87 (53%) women and were associated with reported incontinence at both three months (RR 1.9; 95% CI 1.4-2.6) and 30 months (RR 1.9; 95% CI 1.3-2.8) after delivery. The prevalence of anal incontinence at 30 months was highest (5/13, 39%) among those in whom a sphincter defect was diagnosed by endosonography after their first delivery and with a second delivery.

Conclusion Anal incontinence after childbirth is associated with defects of the anal sphincter diagnosed by endosonography. Subsequent deliveries increase the risk of incontinence, particularly among women with a sphincter defect diagnosed after the first delivery.

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