INTRODUCTION AND HYPOTHESIS: The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces-solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20 years after one vaginal (VD) or one caesarean section (CS). METHODS: This was a registry-based national cohort study of primiparae giving birth in 1985-1988 and having no further births (n = 5,236). Data from the Swedish Medical Birth Register were linked to information from a pelvic floor disorder questionnaire in 2008 (response rate 65.2%). Analysis of variance and multivariate analysis were used to obtain adjusted prevalence and odds ratios (adj-OR). RESULTS: Overall prevalences of FI and AI were 13.6 and 47.0%. FI prevalence was higher after VD compared with CS [14.5 versus 10.6%, adj-OR 1.43, 95% confidence interval (CI) 1.16-1.77] but was not increased after acute versus elective CS. Perineal tear (≥second degree) increased the prevalence and risk of FI compared with no tear (22.8 versus 13.9%, adj-OR 1.95, 95% CI 1.33-2.85). The prevalence of FI was lower after VD with an episiotomy (11.1%) and similar to that after CS (10.6%). With each unit increase of current body mass index the odds of FI increased by 6% (OR 1.06, 95% CI 1.04-1.08). CONCLUSIONS: Late FI and AI prevalences were higher after VD compared with CS. Perineal tear (≥second degree) versus no tear doubled the prevalence of FI. FI prevalence was similar after a CS and a VD combined with episiotomy.
INTRODUCTION AND HYPOTHESIS: The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces-solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20 years after one vaginal (VD) or one caesarean section (CS). METHODS: This was a registry-based national cohort study of primiparae giving birth in 1985-1988 and having no further births (n = 5,236). Data from the Swedish Medical Birth Register were linked to information from a pelvic floor disorder questionnaire in 2008 (response rate 65.2%). Analysis of variance and multivariate analysis were used to obtain adjusted prevalence and odds ratios (adj-OR). RESULTS: Overall prevalences of FI and AI were 13.6 and 47.0%. FI prevalence was higher after VD compared with CS [14.5 versus 10.6%, adj-OR 1.43, 95% confidence interval (CI) 1.16-1.77] but was not increased after acute versus elective CS. Perineal tear (≥second degree) increased the prevalence and risk of FI compared with no tear (22.8 versus 13.9%, adj-OR 1.95, 95% CI 1.33-2.85). The prevalence of FI was lower after VD with an episiotomy (11.1%) and similar to that after CS (10.6%). With each unit increase of current body mass index the odds of FI increased by 6% (OR 1.06, 95% CI 1.04-1.08). CONCLUSIONS: Late FI and AI prevalences were higher after VD compared with CS. Perineal tear (≥second degree) versus no tear doubled the prevalence of FI. FI prevalence was similar after a CS and a VD combined with episiotomy.
Authors: R L Nelson; C Go; R Darwish; J Gao; R Parikh; C Kang; A Mahajan; L Habeeb; P Zalavadiya; M Patnam Journal: Tech Coloproctol Date: 2019-07-04 Impact factor: 3.781
Authors: Tony Bazi; Satoru Takahashi; Sharif Ismail; Kari Bø; Alejandra M Ruiz-Zapata; Jonathan Duckett; Dorothy Kammerer-Doak Journal: Int Urogynecol J Date: 2016-03-12 Impact factor: 2.894
Authors: Aideen T O'Neill; Joanne Hockey; Patrick O'Brien; Amanda Williams; Tim P Morris; Tahira Khan; Emma Hardwick; Wai Yoong Journal: Int Urogynecol J Date: 2016-08-10 Impact factor: 2.894